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A comparison of the cost effectiveness of one-stage versus two-stage bilateral total hip replacement
M Lorenze1, M H Huo, L E Zatorski
1Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA.
Insights
Performing bilateral total hip replacements (THRs) in one stage significantly reduces hospital charges by 24% compared to two-stage procedures. This cost-saving is mainly due to a shorter hospital stay for one-stage bilateral total hip replacements.
Area of Science:
- Orthopedic Surgery
- Health Economics
Background:
- Total hip replacement (THR) is a common procedure for hip joint issues.
- Bilateral THRs can be performed in one stage (simultaneously) or two stages (separately).
- The economic implications of one-stage versus two-stage bilateral THR are not fully elucidated.
Purpose of the Study:
- To compare the total hospital charges between one-stage bilateral primary total hip replacements and two-stage bilateral primary total hip replacements.
- To identify factors contributing to cost differences between the two surgical approaches.
Main Methods:
- A retrospective analysis compared 40 patients undergoing 80 one-stage bilateral primary THRs with 40 matched patients undergoing unilateral primary THRs (assumed as the first stage of a two-stage bilateral THR).
- Patient matching considered age, sex, diagnosis, weight, comorbidities, prosthesis type, and perioperative management.
- Total hospital charges were analyzed between the one-stage bilateral THR group and the assumed two-stage bilateral THR group.
Main Results:
- One-stage bilateral total hip replacements resulted in an average 24% reduction in total hospital charges per case compared to the two-stage approach (P<.05).
- The primary driver for cost reduction was a significant decrease in the length of hospital stay for the one-stage group (P<.05).
- No significant differences were observed in operative time, estimated blood loss, or perioperative complications between the groups.
Conclusions:
- Performing bilateral total hip replacements in a single stage is more cost-effective than a two-stage approach.
- The economic benefits of one-stage bilateral THR are primarily attributed to reduced hospital length of stay.
- One-stage bilateral total hip replacement offers a safe and economically advantageous alternative without compromising surgical outcomes or increasing complications.
Abstract:
Forty patients underwent 80 bilateral primary total hip replacements (THRs) under the same anesthesia (one-stage). Forty other patients who underwent unilateral primary THRs during the same time interval were selected to match the first 40 patients with regard to age, sex, diagnosis, weight, medical comorbidity, type of prosthesis used, and perioperative management protocol. An assumption was made in that each unilateral case represented the first side of bilateral THRs performed during two separate hospitalizations (two-stage). Analysis of the total hospital charges submitted to the insurance companies was made between the groups. On average, there was a 24% reduction (P<.05) for each case if bilateral THRs were done in one stage. This was primarily due to a significant decrease (P<.05) in the length of hospital stay in the one-stage group. There was no difference between the two groups in the operative time, estimated blood loss, or perioperative complications.