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Risk Factors for Increased Hospital Costs for Primary Total Hip Arthroplasty
Hemant P Reddy1, Michael Biskup2, Jonathan Rubin1
1Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Insights
Higher body mass index (BMI) and certain comorbidities like peripheral vascular disease (PVD), chronic pulmonary disease (CPD), renal disease, and higher American Society of Anesthesiologists (ASA) scores increase total hip arthroplasty (THA) costs. These factors significantly impact hospital expenses for THA patients.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Medical Informatics
Background:
- Patient medical complexity significantly elevates the costs associated with primary total hip arthroplasty (THA).
- Understanding the financial impact of specific comorbidities is crucial for cost management in THA.
- This study quantifies the real hospital cost implications of various medical conditions in THA patients.
Purpose of the Study:
- To determine the association between specific medical comorbidities and the actual hospital costs of primary total hip arthroplasty (THA).
- To identify patient factors that independently predict increased inpatient expenses for THA procedures.
- To provide data for optimizing resource allocation and cost-effectiveness in THA.
Main Methods:
- Retrospective analysis of 1,222 primary THA (CPT code 27130) encounters from January 2017 to March 2020.
- Collected patient demographics, comorbidities, and admission data from a high-volume urban academic medical center.
- Utilized univariate and multivariate gamma regression to identify factors associated with increased THA hospital costs.
Main Results:
- Median THA cost was $30,580. Increased costs were linked to higher BMI (>35), ASA scores (3-4), diabetes, congestive heart failure, PVD, CPD, and renal disease.
- Multivariate analysis confirmed independent associations between higher BMI, ASA 3-4, PVD, CPD, and renal disease with increased THA costs.
- Elevated costs in patients with BMI > 35 were primarily driven by room/board and operating room expenses.
Conclusions:
- Obesity (BMI > 35), peripheral vascular disease (PVD), chronic pulmonary disease (CPD), renal disease, and higher American Society of Anesthesiologists (ASA) scores (3-4) are significant predictors of higher inpatient hospital costs for THA.
- These comorbidities independently contribute to increased financial burden during THA admissions.
- Identifying and managing these risk factors may help mitigate rising healthcare costs for THA.
Background:
Patient medical complexity increases the cost of primary total hip arthroplasty (THA). The goal of this study was to quantify the impact of specific medical comorbidities on the real hospital cost of primary THA.
Methods:
This study consisted of a retrospective analysis of 1,222 patient encounters for Current Procedural Terminology code 27130 (primary THA) between January 2017 and March 2020 at a high-volume urban academic medical center. Patient demographics, comorbidities, and admission data were collected, and univariate and multivariate gamma regression analyses were performed to identify associations with increased costs incurred during THA admission.
Results:
The median total cost for THA was $30,580. Univariate analysis showed increased cost for body mass index (BMI) > 35 versus BMI < 35 ($31,739 versus 30,071; P < .05), American Society of Anesthesiologists (ASA) score 3 to 4 versus ASA 1 to 2 ($32,268 versus 30,045; P < .05), prevalence of diabetes ($31,523 versus 30,379; P < .05), congestive heart failure ($34,814 versus 30,584; P < .05), peripheral vascular disease (PVD) ($35,369 versus 30,573; P < .05), chronic pulmonary disease (CPD) ($34,625 versus 30,405; P < .05), renal disease ($31,973 versus 30,352; P < .05), and increased length of stay (r = 0.424; P < .05). Multivariate gamma regression showed that BMI > 35 (relative risk [RR] = 1.05), ASA 3 to 4 (RR = 1.07), PVD (RR = 1.29), CPD (RR = 1.13), and renal disease (RR = 1.09) were independently associated with increased THA hospital cost (P < .01). Increased costs seen in BMI > 35 versus BMI < 35 patients were largely due to hospital room and board ($6,345 versus 5,766; P = .01) and operating room costs ($5,744 versus 5,185; P < .05).
Conclusions:
A BMI > 35, PVD, CPD, renal disease, and ASA 3 to 4 are associated with higher inpatient hospital costs for THA.
Level Of Evidence:
Level III; Retrospective cohort study.
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