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Quantifying and Predicting Surgeon Work Input in Primary vs Revision Total Hip Arthroplasty
Mark J Isaacson1, Kevin J Bunn1, Philip C Noble2
1Houston Methodist Orthopedics and Sports Medicine, Houston, Texas.
Insights
Revision total hip arthroplasty (THA) requires significantly more work and has higher readmission rates than primary THA. Current Medicare reimbursement may not adequately compensate for this increased effort, potentially limiting patient access to revision procedures.
Area of Science:
- Orthopedic surgery
- Arthroplasty research
- Health economics
Background:
- Primary total hip arthroplasties (THAs) are projected to increase significantly, leading to a parallel rise in revision THAs.
- Increased surgical effort and readmission rates for revision THA may deter surgeons.
- Current Medicare reimbursement for revision THA may not align with the increased time and effort involved.
Purpose of the Study:
- To examine and compare the work input required for primary versus revision THA.
- To identify patient factors that predict outcomes in THA.
- To compare surgeon work input for THA procedures with current Medicare reimbursement rates.
Main Methods:
- A retrospective review of 156 patients (80 primary, 76 revision THA) was conducted.
- Demographic, clinical, and radiographic data were collected and analyzed.
- Multiple regression models were used to identify factors influencing surgical outcomes.
Main Results:
- Demographics were similar between primary and revision THA cohorts.
- Patient variables were identified that significantly increased surgical time, length of stay, blood loss, and complications for revision THA.
- Revision THA demonstrated a substantial increase in work effort.
Conclusions:
- Revision THA demands significantly more work effort (at least double) and has a higher readmission rate compared to primary THA.
- The increased work effort for revision THA is not adequately compensated by current Medicare reimbursement.
- Inadequate reimbursement may lead surgeons to limit revision THA procedures, potentially reducing patient access to care.
Background:
Primary total hip arthroplasties (THAs) performed annually are projected to increase 174% by 2030, causing a parallel increase for revision THA. Increased surgical effort and readmission rates associated with revision THA may discourage surgeons from performing them. Although revision THA Medicare reimbursement is greater, it may be disproportionate to time and effort. We examined work input between primary and revision THA, assessing predictive factors. We also compared surgeon work input to current reimbursement.
Methods:
A total of 156 patients were identified, 80 primary and 76 revision THA. Demographic, clinical, and radiographic data were collected. Radiographic data were collected from the most recent preoperative radiographs taken before primary or revision THA. Multiple linear and logistic regression models were used to identify patient factors contributing to select outcome variables by a stepwise method, with a probability value for entry (P = .05) and removal (P = .10). Residual analysis was performed, confirming validity of these models.
Results:
Average age, body mass index, and percentage of female patients were similar between cohorts. There was no statistically significant difference between the demographic variables, although data revealed patient variables contributing to statistically significant increases in surgical time, length of stay, blood loss, and complications with revision THA.
Conclusion:
Despite a 66% increase in "percent effort" and 3-fold higher readmission rate, revision THA requires at least a 2-fold increase because of nonquantifiable factors. Revision THA demonstrates a substantial increase in work effort not commensurate with current Medicare reimbursement, which may force surgeons to limit or eliminate revision arthroplasties performed reducing access to patient care.
