Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

Abstract

Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are required for many patients. No recent studies that concentrate on the costs for each of the payment items both for TKA and THA when comparing simultaneous bilateral procedures with staged arthroplasty. This study aimed to evaluate the medical costs, length of stay(LOS), blood transfusion, and in-hospital complications in patients undergoing simultaneous TKA or THA and staged TKA or THA. Methods A retrospective cohort study was conducted by analyzing 1,579 patients from a single institution. All patients who underwent primary bilateral TKA or THA from 2013 to 2018 were divided into three groups: TKA,THA and all patients. Then, we grouping simultaneous bilateral groups and staged bilateral groups in these three groups respectively. Finally, these two sub-groups(simultaneous bilateral groups and staged bilateral groups) were compared between the three groups(TKA, THA, and pooled groups). Results All categories of medical costs, except for materials fees which were higher in the simultaneous bilateral THA and pooled groups but with no statistical significance, were lower in the simultaneous TKA, THA and pooled simultaneous groups. The total average medical costs in simultaneous and staged bilateral TKA groups were $15,535.621and $16,747.192, p <0.001), respectively; THA groups were $15,046.210 and $16,126.808, ( p =0.003), respectively; pooled groups were $16,506.971and $15,467.561, ( p <0.001), respectively. All costs were presented in the United States dollar. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common co-morbidities and postoperative complications between the two sub-groups in three groups. The simultaneous groups had a shorter LOS, a higher incidence of blood transfusion than staged groups whether it is TKA groups or THA or pooled groups. Conclusions These results indicate that simultaneous bilateral TKA and THA with a shorter LOS is more economical than staged bilateral TKA and THA. Counts of complications were not affected by the choice for staged or simultaneous bilateral total arthroplasty. But blood transfusion was more prevalent in the simultaneous groups both for TKA and THA.