Medical Comorbidities Impact The Episode of Care Reimbursements of Total Hip Arthroplasty

Abstract Background Total hip arthroplasty (THA) costs are a source of great interest in the currently evolving healthcare market. The initiation of a bundled payment system has led to further research into costs drivers of this commonly performed procedure. One aspect that has not been well studied is the effect of comorbidities on the reimbursements of THA. The purpose of this study was to determine if common medical comorbidities affect these reimbursements. Methods A retrospective, level of evidence III study was performed using the PearlDiver Supercomputer to identify patients who underwent primary THA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using ANOVA for reimbursements the day of surgery, and over the 90-day postoperative period. Results A cohort of 250,343 patients was identified. Greatest reimbursements the day of surgery were found among patients with a history of cirrhosis, morbid obesity, obesity, CKD and hepatitis C. Patients with cirrhosis, hepatitis C, COPD, atrial fibrillation and CKD incurred in the greatest reimbursements over the 90 day period following surgery. Conclusion Medical comorbidities significantly impact reimbursements, and inferentially costs, following THA. The most costly comorbidities at 90-days include: cirrhosis, hepatitis c, COPD, atrial fibrillation and CKD.