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Patient Comorbidity Status and Incremental Total Hospitalization Costs in Elective Orthopedic Procedures
Insights
Highly comorbid patients undergoing total knee arthroplasty (TKA), total hip arthroplasty (THA), or spinal fusion have longer hospital stays and higher costs. This highlights the need for improved care standards for these patients.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Health Economics
Background:
- Patient comorbidity significantly impacts healthcare resource utilization.
- Elective orthopedic procedures like TKA, THA, and spinal fusion represent a substantial healthcare expenditure.
- Understanding cost drivers in these procedures is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To examine the correlation between patient comorbidity status, hospitalization length of stay (LOS), and total hospitalization cost for TKA, THA, and lumbar spinal fusion.
- To quantify the incremental cost associated with higher comorbidity burden in patients undergoing these elective orthopedic procedures.
Main Methods:
- Utilized the Premier Perspective Database to identify adult patients (≥18 years) undergoing primary unilateral TKA, THA, or 1- to 3-level lumbar spinal fusion between January 2008 and June 2014.
- Employed generalized linear models to predict incremental total hospitalization costs, controlling for demographic and hospital-related factors.
- Assessed patient comorbidity using the Charlson Comorbidity Index (CCI), comparing patients with CCI ≥3 (highly comorbid) to those with CCI=0 (healthy controls).
Main Results:
- The study included a large cohort: 536,582 TKAs, 275,953 THAs, and 177,493 spinal fusions.
- Highly comorbid patients (CCI ≥3) experienced longer mean LOS (0.9 days for TKA, 1.4 for THA, 2.3 for spinal fusion) compared to healthy controls (CCI=0).
- Incremental total hospitalization costs for highly comorbid patients were $2211 (TKA), $3041 (THA), and $3922 (spinal fusion) compared to controls.
Conclusions:
- Highly comorbid patients, despite being a smaller proportion of the overall cohort, incur significantly greater hospitalization costs for TKA, THA, and spinal fusion.
- The findings underscore the substantial economic impact of comorbidities in elective orthopedic surgery.
- Further research into optimized care pathways for comorbid patients undergoing these procedures is warranted, especially given the national trend of increasing patient comorbidity.
Abstract:
This study examined the correlation between patient comorbidity status, hospitalization length of stay (LOS), and cost for total knee arthroplasty (TKA), total hip arthroplasty (THA), and 1- to 3-level lumbar spinal fusion procedures. Using the Premier Perspective Database, adults older than 18 years who underwent primary unilateral TKA, THA, or spinal fusion between January 1, 2008, and June 30, 2014, were identified. Generalized linear models controlling for age, sex, region, hospital size, academic status, payor, and procedure year predicted the incremental total hospitalization cost among the sickest patients (Charlson Comorbidity Index [CCI] ≥3) vs healthy controls (CCI=0). The study cohort included 536,582 TKAs, 275,953 THAs, and 177,493 spinal fusion procedures. The percentages of patients with a CCI of 3 or greater were 5.4%, 4.7%, and 4.3%, for TKA, THA, and spinal fusion procedures, respectively. Mean (SD) LOS was longer by 0.9 (1.5), 1.4 (2.3), and 2.3 (3.8) days for patients with a CCI of 3 or greater vs 0 for TKA, THA, and spinal fusion procedures, respectively. Unadjusted total hospitalization costs were $17,512 for TKA, $18,915 for THA, and $32,932 for spinal fusion procedures; generalized linear models showed an incremental total hospitalization cost for CCI scores of 3 or greater of $2211, $3041, and $3922 vs CCI equal to 0 for each procedure type, respectively. Although representing a relatively small proportion of all patients undergoing elective orthopedic procedures, highly comorbid patients were associated with a greater total hospitalization cost burden. With the average patient comorbidity burden growing nationally, this study warrants further examination of improved standards of care for comorbid patients undergoing elective orthopedic procedures. [Orthopedics. 2016; 39(4):237-246.].
