Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis
Abstract Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Med...
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| Veröffentlicht in: | The Journal of arthroplasty 2016-02, Vol.31 (2), p.362-367 |
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| creator | Chin, Garwin, BSc Wright, David J., MSc Snir, Nimrod, MD Schwarzkopf, Ran, MD, MSc |
| description | Abstract Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients ( Current Procedure Terminology code 27132) and 105 matched primary THA patients ( Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different ( P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. |
| doi_str_mv | 10.1016/j.arth.2015.08.014 |
| format | Article |
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In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients ( Current Procedure Terminology code 27132) and 105 matched primary THA patients ( Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different ( P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2015.08.014</identifier><identifier>PMID: 26387923</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip - economics ; conversion total hip arthroplasty ; cost ; Costs and Cost Analysis ; Female ; Hip Fractures - economics ; Hip Fractures - surgery ; Hospital Costs ; Humans ; implant cost ; Male ; Medicare - economics ; Middle Aged ; Orthopedics ; primary total hip arthroplasty ; revision total hip arthroplasty ; Time Factors ; United States</subject><ispartof>The Journal of arthroplasty, 2016-02, Vol.31 (2), p.362-367</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c580t-ea309bda4443c921e401fcf78d17b2b2c3f73373c1e8772dd378492dea6a26843</citedby><cites>FETCH-LOGICAL-c580t-ea309bda4443c921e401fcf78d17b2b2c3f73373c1e8772dd378492dea6a26843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883540315007688$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26387923$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chin, Garwin, BSc</creatorcontrib><creatorcontrib>Wright, David J., MSc</creatorcontrib><creatorcontrib>Snir, Nimrod, MD</creatorcontrib><creatorcontrib>Schwarzkopf, Ran, MD, MSc</creatorcontrib><title>Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Abstract Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients ( Current Procedure Terminology code 27132) and 105 matched primary THA patients ( Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different ( P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthroplasty, Replacement, Hip - economics</subject><subject>conversion total hip arthroplasty</subject><subject>cost</subject><subject>Costs and Cost Analysis</subject><subject>Female</subject><subject>Hip Fractures - economics</subject><subject>Hip Fractures - surgery</subject><subject>Hospital Costs</subject><subject>Humans</subject><subject>implant cost</subject><subject>Male</subject><subject>Medicare - economics</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>primary total hip arthroplasty</subject><subject>revision total hip arthroplasty</subject><subject>Time Factors</subject><subject>United States</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhi0EokvhD3BAOXJJGH8kdhBUWq1oi1QJJMp55HUm1Es2XuzsSvvv62hLBRw4WZbfj_EzjL3mUHHgzbtNZeN0VwngdQWmAq6esAWvpSiNguYpW4AxsqwVyDP2IqUNAOd1rZ6zM9FIo1shF-zj1-i3Nh6LQypWYTxQTD6MxW2Y7FBc-12xzBUx7AabpuP7YplFaSqWox2OyaeX7Flvh0SvHs5z9v3y0-3qurz5cvV5tbwpXW1gKslKaNedVUpJ1wpOCnjvem06rtdiLZzstZRaOk5Ga9F1UhvVio5sY0VjlDxnF6fc3X69pc7ROEU74O40Owbr8e-X0d_hj3DA2jRSizYHvH0IiOHXntKEW58cDYMdKewTct3kIlB8loqT1MWQUqT-sYYDztxxgzN3nLkjGMzcs-nNnwM-Wn6DzoIPJwFlTAdPEZPzNDrqfCQ3YRf8__Mv_rG7wY_e2eEnHSltwj7mleR_YBII-G3e_Lx4XgPoJl_uAQ5dqRk</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Chin, Garwin, BSc</creator><creator>Wright, David J., MSc</creator><creator>Snir, Nimrod, MD</creator><creator>Schwarzkopf, Ran, MD, MSc</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160201</creationdate><title>Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis</title><author>Chin, Garwin, BSc ; Wright, David J., MSc ; Snir, Nimrod, MD ; Schwarzkopf, Ran, MD, MSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c580t-ea309bda4443c921e401fcf78d17b2b2c3f73373c1e8772dd378492dea6a26843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthroplasty, Replacement, Hip - economics</topic><topic>conversion total hip arthroplasty</topic><topic>cost</topic><topic>Costs and Cost Analysis</topic><topic>Female</topic><topic>Hip Fractures - economics</topic><topic>Hip Fractures - surgery</topic><topic>Hospital Costs</topic><topic>Humans</topic><topic>implant cost</topic><topic>Male</topic><topic>Medicare - economics</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>primary total hip arthroplasty</topic><topic>revision total hip arthroplasty</topic><topic>Time Factors</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chin, Garwin, BSc</creatorcontrib><creatorcontrib>Wright, David J., MSc</creatorcontrib><creatorcontrib>Snir, Nimrod, MD</creatorcontrib><creatorcontrib>Schwarzkopf, Ran, MD, MSc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chin, Garwin, BSc</au><au>Wright, David J., MSc</au><au>Snir, Nimrod, MD</au><au>Schwarzkopf, Ran, MD, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>31</volume><issue>2</issue><spage>362</spage><epage>367</epage><pages>362-367</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Abstract Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients ( Current Procedure Terminology code 27132) and 105 matched primary THA patients ( Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different ( P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26387923</pmid><doi>10.1016/j.arth.2015.08.014</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Arthroplasty, Replacement, Hip - economics conversion total hip arthroplasty cost Costs and Cost Analysis Female Hip Fractures - economics Hip Fractures - surgery Hospital Costs Humans implant cost Male Medicare - economics Middle Aged Orthopedics primary total hip arthroplasty revision total hip arthroplasty Time Factors United States |
| title | Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis |
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