Revision total knee replacement: A two-year review of complexity data and regional workload in South West England

Phillips, Jonathan; Evans, Jonathan; Searle, D.; Sword,; Toms, Andrew

doi:10.1016/j.knee.2021.05.010

Cited by 4 publications

(7 citation statements)

References 9 publications

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“…However, the relationship between operating volume and surgical outcome is unlikely to be straightforward. Higher-volume centres are more likely to be presented with complex cases [ 10 ], which might be expected to have poorer outcomes. Similarly, centres with more modest caseloads and well-organised multidisciplinary teams might be able to achieve good outcomes for patients, maintain continuity of care and minimise travel for patients [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…As such, as well as looking at minimum operating volumes, it is also important to examine individual cases themselves in more detail. A recent study from the Southwest of England [ 10 ] used the Revision Knee Complexity Classification (RKCC) [ 12 ] to examine regional rTKR practice. They found that, to some extent, a network model was already in existence in their region, with more complex cases and higher volumes of rTKR surgery being performed at their high-volume centre.…”

Section: Introductionmentioning

confidence: 99%

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Revision total knee replacement case-mix at a major revision centre

et al. 2022

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Revision total knee replacement case-mix at a major revision centre

et al. 2022

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“…The South West region of the UK is a tting case study for a cost based analysis, it has a stable network and has been using the RKCC in clinical practice since 2018. In line with GIRFT philosophy and recommendations (2), the South West region formed a preliminary network of care, the South West Knee Group (10). This network consisted of Trusts across the region who, through the implementation of the RKCC had a platform through which MDT discussion could take place at regional and local level.…”

Section: Discussionmentioning

confidence: 99%

“…The authors have previously discussed cost complexity of revision total knee replacement (10). The care episode cost is most likely to be driven by the complexity of the revision procedure; more complex cases being associated with increased theatre time, increased blood loss, increased risk of patient morbidity, longer length of stay in hospital.…”

Section: Introductionmentioning

confidence: 99%

“…The care episode cost is most likely to be driven by the complexity of the revision procedure; more complex cases being associated with increased theatre time, increased blood loss, increased risk of patient morbidity, longer length of stay in hospital. The authors have also discussed how remuneration for revision knee replacement currently is not re ective of complexity but suggest that this potentially ought to be the case (10). This was shown to be the case by Petrie et al (2021) at another high-volume centre, whereby it was demonstrated that the current tariff and remuneration scheme for RKR service results in units recording losses for almost all procedures carried out and places an increased nancial burden on units carrying out higher volumes of complex work (10).…”

Section: Introductionmentioning

confidence: 99%

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Revision Total Knee replacement finances: a detailed cost-analysis of operative practice at a regional tertiary referral centre

Alexiadis

Reynolds

Al-Mouazzen

et al. 2023

Preprint

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Background: The revision knee complexity classification (RKCC) stratifies knee revision operations depending on their level of complexity from simple revisions (R1) to highly complex cases (R3). Current financial codes used for calculation of reimbursement for knee revision services provided at the Trust, rely on patients’ comorbidities. However, previous research has demonstrated that this approach may not yield an accurate financial account of knee revision arthroplasty cost. This is a single centre study from a secondary and tertiary revision unit, with work previously presented by the authors demonstrating that the majority of complex revision knee replacement within the region, take place in this unit. The aims of this study were to illustrate the current cost profile and renumeration service currently in place for revision knee and show the differences in cost based on complexity of the operation. Methods: In this retrospective study, 89 cases who underwent revision knee operations in 2019 were analysed. Data was obtained from a tertiary referral centre where the episodes had occurred. Mean cost, tariff, and subsequent deficit were calculated for the R1, R2 and R3 episodes. Results: R2 and R3 episodes were significantly more expensive than R1 episodes. The increase in cost between R3 and R2 episodes was not significant. The total cost of the revision operations was £1,162,343. Tariffs received for R2 and R3 revision operations were significantly more expensive than R1 operations. However, the increase in tariffs received for R3 operations was not significant in relation to R2 operations. The total amount of tariffs received by the Trust was £ 770,996 generating a net deficit of - £ 391,347. Conclusion Current financial coding for revision knee does not accurately predict costs associated with revision knee surgery. Net deficit varies depending on the RKCC grade of the knee revision episode with more complex operations resulting in a higher mean net deficit. Implementation of the RKCC could prove to be a useful tool in generating an accurate prediction of the cost associated with knee revision surgery.

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