Ashkenazi Itay, Katzman Jonathan, Thomas Jeremiah, Davidovitch Roy, Meftah Morteza, Schwarzkopf Ran
Department of Orthopaedic Surgery, NYU Langone Health, New York, New York; Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Department of Orthopaedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2024 Sep;39(9):2188-2194. doi: 10.1016/j.arth.2024.04.056. Epub 2024 Apr 25.
With the increasing utilization of total hip arthroplasty (THA) in patients who have a high comorbidity burden (HCB), coinciding with modifications to reimbursement models over the past decade, an evaluation of the financial impact of HCB on THA over time is warranted. This study aimed to investigate trends in revenue and cost associated with THA in HCB patients.
Of 13,439 patients who had primary, elective THA between 2013 and 2021 at our institution, we retrospectively reviewed 978 patients considered to have HCB (Charlson comorbidity index ≥ 5 and American Society of Anesthesiology scores 3 or 4). We collected patient demographics, perioperative data, revenue, cost, and contribution margin (CM) of the inpatient episode. We analyzed changes as a percentage of 2013 values over time for these financial markers. Linear regression determined trend significance. The final analysis included 978 HCB patients who had complete financial data.
Between 2013 and 2021, direct costs increased significantly (P = .002), along with a nonsignificant increase in total costs (P = .056). While revenue remained steady during the study period (P = .486), the CM decreased markedly to 38.0% of 2013 values, although not statistically significant (P = .222). Rates of 90-day complications and home discharge remained steady throughout the study period.
Increasing costs for HCB patients undergoing THA were not matched by an equivalent increase in revenue, leading to dwindling CMs throughout the past decade. Re-evaluation of reimbursement models for THA that account for patients' HCB may be necessary to preserve broad access to care.
III.
随着全髋关节置换术（THA）在合并症负担较高（HCB）患者中的应用日益增加，同时过去十年报销模式也有所改变，因此有必要评估HCB对THA长期的财务影响。本研究旨在调查HCB患者THA相关的收入和成本趋势。
在2013年至2021年期间于我院接受初次择期THA的13439例患者中，我们回顾性分析了978例被认为合并症负担较高的患者（Charlson合并症指数≥5且美国麻醉医师协会评分3或4）。我们收集了患者的人口统计学资料、围手术期数据、收入、成本以及住院期间的贡献毛利（CM）。我们分析了这些财务指标随时间相对于2013年数值的变化百分比。线性回归确定趋势的显著性。最终分析纳入了978例有完整财务数据的HCB患者。
2013年至2021年期间，直接成本显著增加（P = .002），总成本也有不显著的增加（P = .056）。虽然研究期间收入保持稳定（P = .486），但CM显著下降至2013年数值的38.0%，尽管差异无统计学意义（P = .222）。在整个研究期间，90天并发症发生率和出院回家的比例保持稳定。
接受THA的HCB患者成本增加，但收入未相应增加，导致过去十年贡献毛利不断减少。可能有必要重新评估考虑患者HCB的THA报销模式，以确保广泛的医疗服务可及性。
III级
