Higher Hospital Costs Do Not Result in Lower Readmission Rates Following Total Joint Arthroplasty

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Healthcare Economics

Background:

• Hip and knee arthroplasty are common, successful, yet expensive orthopedic procedures.
• Significant variations exist in procedure volume, patient outcomes, and costs across different hospitals.
• Assessing the relationship between cost, volume, and readmission rates is crucial for understanding healthcare value.

Purpose of the Study:

• To investigate the correlation between the volume of hip and knee arthroplasty procedures performed and their associated costs and readmission rates.
• To determine if higher procedural volumes or costs at hospitals correlate with better or worse patient outcomes, specifically readmission rates.
• To identify factors influencing the value (outcomes divided by cost) of total hip and knee arthroplasty.

Main Methods:

• Utilized the Statewide Planning and Research Cooperative System (SPARCS) database for readmission rates.
• Employed the New York State Department of Health (NYSDoH) hospital cost transparency database for procedure costs.
• Analyzed data for hip and knee replacements to identify relationships between procedure volume, cost, and readmission rates.

Main Results:

• A statistically significant increase in readmission rates was observed with increasing costs for total knee arthroplasty (p = 0.02).
• Readmission rates for total knee arthroplasty did not significantly correlate with the volume of procedures performed.
• Similarly, for total hip arthroplasty, readmission rates increased with higher costs, but volume was not a significant factor (p < 0.01).

Conclusions:

• Increased expenditure on total hip and knee arthroplasty in New York does not necessarily lead to reduced readmission rates.
• Readmission rates for these procedures appear to be independent of the volume of surgeries performed at a facility.
• The findings suggest that focusing solely on procedure volume or cost may not optimize the value and quality of care in hip and knee arthroplasty.