Ninety-day postoperative cost in primary total hip arthroplasty: an economic model comparing surgical approaches

Abstract

Larry E Miller,1 Melissa S Martinson,2 Joseph S Gondusky,3 Atul F Kamath,4 Friedrich Boettner,5 Samir K Bhattacharyya6 1Miller Scientific Consulting, Inc., Asheville, NC 28803, USA; 2Technomics Research, LLC, Long Lake, MN 55356, USA; 3Department of Orthopaedic Surgery, Jordan-Young Institute, Virginia Beach, VA 23462, USA; 4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; 5Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; 6DePuy Synthes, Raynham, MA 02767, USA Background: While primary total hip arthroplasty (THA) is a safe and effective procedure, it is unclear whether choice of surgical approach influences health care cost. Methods: We developed an economic model in which patients receiving THA via the anterior approach (AA) by high volume anterior hip surgeons were compared to a propensity-score matched cohort of primary THA cases performed by high volume surgeons that were identified from Medicare claims (Control). Cost elements included the procedure and hospital stay, postacute care, readmission, and outpatient care through 90 days postoperatively. Costs were derived from Medicare claims and adjusted to account for nationwide payer mix. Results: Health care costs over 90 days postoperative were $17,763 with AA and $23,969 with Control, a difference of $6,206 (95% CI: $5,210–$7,204) per patient. The cost savings with AA were mainly attributable to lower per-patient costs of the index hospitalization ($13,578 vs $16,017), postacute care ($3,123 vs $6,037), and hospital readmissions ($700 vs $1,584). Conclusion: The AA for primary THA was found to lower 90-day health care costs when compared to a matched sample of THA cases. These study findings may be used to inform hospitals and health care payers regarding the cost implications associated with selection of different surgical approaches to primary THA. Keywords: anterior approach, bundle, cost, hip, Medicare, reimbursement, total hip arthroplasty

Keywords

• anterior approach
• bundle
• cost
• hip
• Medicare
• reimbursement
• total hip arthroplasty