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The relationship of hospital charges and volume to surgical site infection after total hip replacement

Rebecca Boas1, Kelsey Ensor1, Edward Qian1

  • 1NYU Hospital for Joint Diseases, New York, NY.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|March 8, 2014
PubMed

Insights

Higher volume hospitals performing total hip replacements (THRs) have increased charges but lower surgical site infection rates. Preventing one infection at high-volume centers correlates with substantial cost increases.

Area of Science:

  • Orthopedic Surgery
  • Health Services Research
  • Infection Control

Background:

  • Hospital volume and charges are key factors influencing healthcare outcomes.
  • Understanding the relationship between these factors and surgical site infections (SSIs) is crucial for patient care and cost-effectiveness.
  • Total hip replacement (THR) is a common procedure where SSIs can lead to significant complications and increased healthcare costs.

Purpose of the Study:

  • To investigate the impact of hospital volume and associated charges on the incidence of surgical site infections (SSIs) following total hip replacements (THRs).
  • To determine the financial implications of SSIs in relation to hospital volume for THR procedures in New York State.

Main Methods:

  • Analysis of a large dataset of 93,620 total hip replacements (THRs) performed in New York State (NYS) between 2008 and 2011.
  • Statistical comparison of surgical site infection rates and hospital charges between high-volume and low-volume hospitals.
  • Examination of the financial impact of preventing surgical site infections in high-volume settings.

Main Results:

  • Hospital charges for THR significantly increased from 2008 to 2011 ($43,713 to $50,652, P<.01).
  • Patients undergoing THR at highest-volume hospitals experienced significantly lower surgical site infection rates (P=.003) compared to lower-volume hospitals.
  • Highest-volume hospitals demonstrated significantly higher total hospital charges (P<.0001).
  • Preventing a single SSI in the highest-volume hospitals was associated with an estimated $1.6 million in increased charges.

Conclusions:

  • Higher hospital volume for total hip replacements is associated with both reduced surgical site infection rates and increased hospital charges.
  • The financial benefit of preventing SSIs in high-volume centers may be offset by increased overall hospital costs.
  • Further research is needed to optimize cost-effectiveness and patient outcomes in total hip replacement surgery across different hospital volumes.

Keywords:
THRchargessurgical site infectiontotal hip replacementvolume

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