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The hospital cost of hip replacement for old inpatients in Belgium
Julie De Foor1,2, Philippe Van Wilder3, Pol Leclercq3
1ICHEC Brussels Management School, Brussels, Belgium. julie.defoor@ichec.be.
Insights
Hip replacement costs are driven by length of stay and patient comorbidities, not age. Complications from existing hip prostheses significantly increase hospital expenses.
Area of Science:
- Orthopedics
- Health Economics
- Healthcare Management
Background:
- Hip joint replacement is a common procedure for patients aged 65 and older.
- Understanding the factors influencing hospital costs is crucial for healthcare resource management.
Purpose of the Study:
- To characterize medico-administrative aspects of hip replacement hospitalizations in older adults.
- To analyze the components of total hospital costs for hip replacement surgery.
- To identify predictors of hospital costs using administrative data.
Main Methods:
- Analysis of 961 inpatient stays for hip replacement (APR-DRG 301) in Belgian hospitals (2014 data).
- Utilized linear regression to identify predictors of hospital cost.
- Categorized costs into medical procedures, drugs, prostheses, and administrative expenses.
Main Results:
- Patients were grouped by primary diagnosis: osteoarthritis (57%), femur neck fracture (30%), and other reasons including complications (13%).
- Median length of stay was 9 days, with a median cost of €8,023.91.
- Key cost predictors included severity of illness, intensive care unit (ICU) stay, in-hospital death, Charlson comorbidity index (4 or 5), complications, and length of stay.
Conclusions:
- Hospital costs for hip replacement are primarily influenced by length of stay and comorbidities, rather than patient age.
- Patients hospitalized due to complications or existing prosthesis issues incur higher costs than those with osteoarthritis-related hip replacements.
Introduction:
The objectives of this research are (i) to describe the medico-administrative characteristics of inpatients aged 65 and more who are hospitalized for hip joint replacement, (ii) to evaluate the complete hospital cost into costs of medical procedures, drugs costs, prostheses costs, and the administrative costs, and (iii) to identify and to evaluate from administrative database predictors influencing the complete hospital costs.
Methods:
The study was based on 961 inpatient stays aged 65 and more, with the APR-DRG 301 "Hip joint replacement". The sample for this study was based on data collected in 2014 among nine Belgian general hospitals. We used the linear regression method for isolating predictors of hospital cost.
Results:
The study highlights three different types of patients hospitalized for hip replacement, depending on the primary diagnosis: osteoarthritis problems (57%), femur neck fracture (30%), or other reasons (13%) (complications, infections, or problems with the existing hip prosthesis). The median length of stay (P25-P75) was 9 days (6.29-20.91). The median cost (P25-P75) was 8,023.91 EUR (6678.32-13,670.78). The total cost was composed of the direct hospital cost (30%), the cost of medical procedures (31%), cost of drugs (4%), the cost of hip prosthesis (18%), and other costs (17%). The linear regression reveals that an extreme SOI or risk of mortality, an ICU stay, an in-hospital death, an index of Charlson comorbidities of 4 or 5, to be hospitalized for a hip replacement because of complications, infections, or problems with the existing hip prosthesis, and the length of stay, were predictors of an increase in hospital cost.
Conclusion:
The cost is not increasing with the age of the patient, but mainly with the length of stay and the comorbidities linked to the age which are considered in the severity of illness and the Charlson comorbidities index. The hospital cost is higher for patients hospitalized for complications linked to an existing hip prosthesis than for a hip replacement linked to osteoarthritis problems.
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