Rajahraman Vinaya, Ashkenazi Itay, Thomas Jeremiah, Bosco Joseph, Davidovitch Roy, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Department of Orthopedic Surgery, NYU Langone Health, New York, New York; Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
J Arthroplasty. 2024 Sep;39(9):2195-2199. doi: 10.1016/j.arth.2024.04.065. Epub 2024 Apr 25.
Though previous studies have demonstrated improved cost benefits associated with simultaneous versus staged bilateral total hip arthroplasty (simBTHA and staBTHA), further investigation is needed regarding the revenues and contribution margins (CMs) of these procedures. In this study, we compared revenue, CM, and surgical outcomes between simBTHA and staBTHA.
All patients who underwent simBTHA (both procedures completed the same day) and staBTHA (procedures completed on different days within one year) between 2011 and 2021 at a single high-volume orthopedic specialty hospital were identified. Of the 1,517 identified patients (n = 139 simBTHA, n = 1,378 staBTHA), 232 were included in a 1:1 propensity match based on baseline demographics (116 per cohort). Revenue, costs, CM, and surgical outcomes were compared between cohorts.
Compared to staBTHA, simBTHA procedures had significantly lower total costs (P < .001), direct costs (P < .001), and patient revenue. There was no significant difference in CM between groups (P = .361). Additionally, there were no significant differences in length of stay (P = .173), operative time (P = .438), 90-day readmissions (P = .701), 90-day revisions (P = .313), or all-cause revisions (P = .701) between cohorts.
Though simBTHA procedures have lower revenues than staBTHA, they also have lower costs, resulting in similar CM between procedures. As both procedures have similar postoperative complication rates, further research is required to evaluate specifically which patients may benefit from simBTHA versus staBTHA regarding clinical and patient-reported outcomes.
III.
尽管先前的研究表明，同期双侧全髋关节置换术（simBTHA）与分期双侧全髋关节置换术（staBTHA）相比具有更好的成本效益，但仍需对这些手术的收入和边际贡献（CM）进行进一步研究。在本研究中，我们比较了simBTHA和staBTHA的收入、CM和手术结果。
确定了2011年至2021年期间在一家大型骨科专科医院接受simBTHA（同一天完成双侧手术）和staBTHA（一年内不同日期完成手术）的所有患者。在1517名确定的患者中（n = 139例simBTHA，n = 1378例staBTHA），根据基线人口统计学特征进行1:1倾向匹配，纳入232名患者（每组116名）。比较两组之间的收入、成本、CM和手术结果。
与staBTHA相比，simBTHA手术的总成本（P <.001）、直接成本（P <.001）和患者收入显著更低。两组之间的CM无显著差异（P =.361）。此外，两组之间的住院时间（P =.173）、手术时间（P =.438）、90天再入院率（P =.701）、90天翻修率（P =.313）或全因翻修率（P =.701）均无显著差异。
尽管simBTHA手术的收入低于staBTHA，但成本也更低，导致两种手术的CM相似。由于两种手术的术后并发症发生率相似，因此需要进一步研究，以具体评估哪些患者在临床和患者报告的结果方面可能从simBTHA与staBTHA中获益。
III级
