Conversion Total Knee Arthroplasty is Associated with Increased Post-Acute Care Costs

Yayac, Michael; Harrer, Samantha L.; Deirmengian, Gregory K.; Parvızı, Javad; Courtney, P. Maxwell

doi:10.1016/j.arth.2019.06.059

Cited by 9 publications

(10 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, conversion TKA represents a heterogeneous set of procedures with intraoperative challenges and postoperative outcomes that differ from those of primary TKA. Patients who undergo such procedures are often subjected to increased costs, greater surgical complexity, higher complication rates, suboptimal short-term outcomes, and potentially decreased survivorship (Table VI) 4 . By gaining an improved understanding of the unique challenges facing patients undergoing conversion TKA, clinicians may better set patient expectations, make intraoperative adjustments, and guide postoperative care.…”

Section: Discussionmentioning

confidence: 99%

“…Although no consensus exists with regard to the definition of conversion TKA, it can be considered as TKA performed after prior periarticular instrumentation (excluding previous TKA) such that implant removal and/or an altered surgical technique are required at the time of the arthroplasty 2 . Growing evidence suggests that conversion TKA requires increased hospital resources, resulting in more complications and readmissions and, in some cases, poorer outcomes 3,4 . However, conversion TKA encompasses a heterogenous group of prior procedures, including arthroscopic ligamentous reconstruction, fracture fixation, periarticular osteotomies for limb axis realignment, and unicompartmental arthroplasties.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Conversion Total Knee Arthroplasty

et al. 2021

View full text Add to dashboard Cite

Conversion total knee arthroplasty (TKA) represents a heterogeneous group of procedures and most commonly includes TKA performed after ligamentous reconstruction, periarticular open reduction and internal fixation (ORIF), high tibial osteotomy (HTO), and unicompartmental knee arthroplasty (UKA).» Relative to patients undergoing primary TKA, patients undergoing conversion TKA often have longer operative times and higher surgical complexity, which may translate into higher postoperative complication rates.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Conversion Total Knee Arthroplasty

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although there is no universal agreement on the definition of convTKA, a subset of these procedures can be regarded as TKA carried out following prior periarticular instrumentation (excluding prior arthroplasty), in which case the implant must be removed or a different surgical approach must be used [1][2][3] . This procedure has been shown to require higher-cost prostheses and to result in increased complication rates, post-acute care costs, and resource utilization overall [4][5][6][7] . Sloan and Lee reported some of these differences in a retrospective study and found that convTKAs more closely resembled aseptic revision TKAs than primary TKAs in terms of length of hospital stay and overall complication, surgical site infection, and reoperation rates 8 .…”

mentioning

confidence: 99%

“…To date, no Current Procedural Terminology (CPT) code exists for conversion of prior knee surgery to TKA, although prior evidence has shown that these cases have an increased complexity [1][2][3][4]9 . While a distinct CPT code for conversion total hip arthroplasty (convTHA) exists, and Medicare has set a higher RVU value for it, there is currently no such adjustment to account for the complexity of convTKA.…”

mentioning

confidence: 99%

Cost Analysis of Conversion Total Knee Arthroplasty

Denyer

Eikani

Bujnowski

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background:Total knee arthroplasty (TKA) after prior knee surgery, also known as conversion TKA (convTKA), has been associated with higher complications, resource utilization, time, and effort. The increased surgical complexity of convTKA may not be reflected by the relative value units (RVUs) assigned under the current U.S. coding guidelines. The purpose of this study was to compare the RVUs of primary TKA and convTKA and to calculate the RVU per minute to account for work effort.Methods:The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was analyzed for the years 2005 to 2020. Current Procedural Terminology (CPT) code 27447 alone was used to identify patients who underwent primary TKA, and 27447 plus 20680 were used to identify convTKA. After 1:1 propensity score matching, 1,600 cases were assigned to each cohort. The 2023 Medicare Physician Fee Schedule RVU-to-dollar conversion factor from the U.S. Centers for Medicare & Medicaid Services (CMS) was used to calculate RVU dollar valuations per operative time. Complication rates were compared using a multivariate logistic regression model controlling for baseline characteristics.Results:The mean operative time for TKA was 97.8 minutes, with a corresponding RVU per minute of 0.25, while the mean operative time for convTKA was 124.3 minutes, with an RVU per minute of 0.19 (p < 0.0001). Using the conversion factor of $33.06 per RVU, this equated to $8.11 per minute for TKA versus $6.39 per minute for convTKA. ConvTKA was associated with higher overall complication (10.9% versus 6.5%, p < 0.0001), blood transfusion (6.6% versus 3.7%, p < 0.01), reoperation (2.3% versus 0.94%, p < 0.0001), and readmission (3.7% versus 1.8%, p < 0.001) rates.Conclusions:The current billing guidelines lead to lower compensation for convTKA despite its increased complexity. The longer operative time, higher complication rate, and increased resource utilization may incentivize providers to avoid performing this operation. CPT code revaluation is warranted to reflect the time and effort associated with this procedure.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…1 2 Additionally, anatomic alterations and hardware implants from prior procedures can result in higher costs and morbidity compared with primary TKA. 9 The limited available literature demonstrates complication rates following conversion TKA aligning closely with revision rather than primary arthroplasty and further examination is warranted.…”

mentioning

confidence: 99%

Is Conversion Total Knee Arthroplasty a Distinct Surgical Procedure? A Comparison to Primary and Revision Total Knee Arthroplasty

et al. 2022

View full text Add to dashboard Cite

Conversion total knee arthroplasty (TKA) is suggested to incur similar complication rates to revision arthroplasties. However, current billing codes do not allow for the differentiation between this operation and primary TKAs. Therefore, the purpose of this study was to compare outcomes of these two surgeries, as well as revision TKAs. Specifically, we analyzed (1) medical complications, (2) surgical complications, and (3) revision rates at 90 days and 1 year. We queried a national, all-payer database to identify patients who underwent TKA without prior implants (n = 1,358,767), required conversion TKA (n = 15,378), and who underwent revision TKA (n = 33,966) between January 1, 2010, and April 30, 2020. Conversion TKA patients (prior implant removal) were identified using the Current Procedural Terminology (CPT) codes. Outcomes studied included 30-day readmission rates and 90-day, as well as 1-year, medical and surgical complications. Conversion TKAs had greater 30-day readmission rates and incidences of most of the complications studied when compared with primary TKAs. The majority of outcomes when comparing between primary, conversion, and revision TKAs were significantly different (p < 0.01). In contrast, conversion TKA complications were similar to revision TKA. Conversion TKAs have higher postoperative complications than primary TKAs and share more similarities with revision TKAs. Thus, the lack of billing codes differentiating conversion and primary TKAs creates a challenge for orthopaedic surgeons.

show abstract

Conversion Total Knee Arthroplasty is Associated with Increased Post-Acute Care Costs

Cited by 9 publications

References 26 publications

Conversion Total Knee Arthroplasty

Conversion Total Knee Arthroplasty

Cost Analysis of Conversion Total Knee Arthroplasty

Is Conversion Total Knee Arthroplasty a Distinct Surgical Procedure? A Comparison to Primary and Revision Total Knee Arthroplasty

Contact Info

Product

Resources

About