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Revision total hip arthroplasty: hospital cost and reimbursement analysis
John F Crowe1, Thomas P Sculco, Barbara Kahn
1The Hospital for Special Surgery, New York, NY, USA. crowe@onsmd.com
Insights
Revision total hip arthroplasty incurs significant hospital costs, averaging a $5402 loss per procedure. Complex cases and older patients, particularly those 65+, drive higher expenses and greater financial losses for hospitals.
Area of Science:
- Orthopedic Surgery
- Health Economics
Background:
- Revision total hip arthroplasty is resource-intensive.
- Accurate cost and reimbursement data are crucial for financial sustainability.
Purpose of the Study:
- To determine the actual hospital costs and reimbursement for revision total hip arthroplasty.
- To stratify patients by revision complexity and analyze associated financial outcomes.
Main Methods:
- Retrospective review of clinical and financial records for 49 patients (51 hips).
- Stratification based on revision complexity.
- Analysis of clinical variables (age, LOS, EBL, transfusions, grafting) and financial costs.
Main Results:
- Hospital costs increase significantly with revision complexity and patient age.
- Femoral bone grafting substantially increases procedure costs.
- Average hospital loss was $5402 per procedure, with older patients (65+) experiencing higher average losses ($8617).
Conclusions:
- Revision total hip arthroplasty is financially challenging for hospitals, especially for complex cases and elderly patients.
- Despite efficiency improvements, significant financial losses persist.
- Further financial analysis and potential reimbursement adjustments are warranted.
Abstract:
Revision total hip arthroplasty is a complex surgical procedure that frequently requires high levels of hospital resources. The purpose of the current study was to report the actual costs and reimbursement to the hospital for a stratified group of patients having revision total hip arthroplasty based on a severity index. The clinical and financial records of 49 patients (51 hips) stratified by complexity of revision were reviewed. Clinical variable included age, length of stay, operating time, estimated blood loss, number of transfusions, implant type, metallic augmentation, use of bone graft, and time spent in the postanesthesia care unit. Financial review included the actual fixed and variable costs associated with each procedure. Hospital costs associated with revision total hip arthroplasty were significantly greater in the most complex revisions and in older patients. The use of bone grafting techniques on the femur resulted in significantly greater costs. The average loss to the hospital was $5402 US dollars per procedure with a range of $5657 (US dollars) profit to $28,780 (US dollars) loss. Procedures in patients younger than 65 years has an average loss of $1133 US dollars. All procedures in patients who were 65 years or older resulted in a loss to the hospital, with the average loss being $8617 US dollars. Despite improvements in length of stay, use of clinical pathways, and negotiated discounts on implants, the hospital loss on each hip revision procedure averaged $5402 US dollars.