Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis
Garwin Chin1, David J Wright1, Nimrod Snir2
1University of California Irvine Medical School, Irvine, California.
Insights
Conversion total hip arthroplasty (THA) is significantly more costly than primary THA, with higher hospital operating and direct costs. This study highlights the need to reclassify conversion THA due to its increased resource use.
Area of Science:
- Orthopedic Surgery
- Health Economics
Background:
- Rising hip fracture incidence necessitates more conversion total hip arthroplasty (THA).
- Current healthcare policy bundles conversion THA with primary THA, despite known higher complication rates.
- This study investigates the economic implications of conversion THA versus primary THA.
Purpose of the Study:
- To compare the treatment costs of conversion THA with primary THA.
- To test the hypothesis that conversion THA incurs higher costs and resource utilization.
Main Methods:
- A comparative study included 51 conversion THA and 105 matched primary THA patients.
- Regression analysis compared natural log-transformed costs, controlling for patient demographics and comorbidities.
- Analysis of variance (ANOVA) analyzed conversion THA subgroups by etiology.
Main Results:
- Conversion THA demonstrated significantly higher costs across multiple metrics.
- Hospital operating direct costs were 29.2% greater for conversion THA.
- Total hospital costs were 26.4% greater for conversion THA compared to primary THA.
Conclusions:
- Conversion THA incurs significantly greater costs and resource use than primary THA.
- The findings support the need for reclassification of conversion THA in healthcare policy.
- Reclassification is crucial to avoid disincentives for treating complex conversion THA patients.
Introduction:
Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA.
Methods:
Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis.
Results:
Conversion and primary THAs were determined to be significantly different (P<.05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater).
Conclusions:
Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.
