Surgical and Medical Costs for Fibromyalgia Patients Undergoing Total Knee Arthroplasty

Abstract

The potential added costs of managing fibromyalgia patients after total knee arthroplasty (TKA) have not been assessed. Therefore, the purpose of this study was to perform a cost analysis of fibromyalgia versus nonfibromyalgia patients who underwent TKA. Specifically, we evaluated the following episodes of care: (1) readmission rates, (2) total costs, (3) total reimbursements, and (4) net losses for surgical and medical complications. Patients who underwent TKAs between 2005 and 2014 from the Medicare Standard Analytical Files of the PearlDiver supercomputer were propensity score matched by patients with and without fibromyalgia in a 1:1 ratio based on age, sex, and the Charlson Comorbidity Index, yielding a total of 305,510 patients distributed equally between the cohorts for analysis. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated. Mean costs, total costs, and total reimbursements were assessed as along with total net losses, which were defined as total costs minus total reimbursements. Fibromyalgia patients had similar 90-day readmission rates compared with nonfibromyalgia patients (OR: 1.03; 95% CI: 1.00–1.06; p = 0.06) but incurred lower readmission costs (US$2,318,384,295 vs. US$2,534,482,404; p < 0.001). Although fibromyalgia patients had higher total reimbursements for medical complications ($27,758,057 vs. US$18,780,610; p < 0.001), the increased management costs (US$106,049,870 vs. US$66,080,469; p < 0.001) led to greater net losses (US$78,291,813 vs. US$47,299,859; p < 0.001). Similarly, although fibromyalgia patients had higher total reimbursements for surgical complications (US$94,192,334 vs. US$73,969,026; p < 0.001), the increased surgical costs (US$382,122,613 vs. US$306,359,910; p < 0.001) led to greater net losses (US$287,930,279 vs. US$232,390,884; p < 0.001). This study highlights some of the potential financial discrepancies of managing patients with fibromyalgia. Our findings suggest medical and surgical complication costs to be greater than reimbursement, resulting in overall net financial losses. These findings need to be considered in the light of health care reform and cost structuring.

Functional somatic syndromes are associated with inferior outcomes and increased complications after hip and knee arthroplasty: a systematic review

“…Four studies ( n = 412,494) reported postoperative complications (Table 4 ). Moore et al (2019) showed that patients with fibromyalgia were 1.95 times more likely to develop any medical complication after TKA than controls (OR = 1.95, 95% CI: 1.86–2.04) [ 31 ]. In terms of reoperation, patients with fibromyalgia were significantly more likely to undergo lysis of adhesions for arthrofibrosis within one year after TKA in one study.…”

“…Patients with FSSs have been shown to incur higher hospitalization costs following shoulder arthroplasty [ 25 ]. In a retrospective database study by Moore et al (2019), patients with fibromyalgia incurred greater management costs for medical and surgical complications following total knee arthroplasty in comparison to patients without fibromyalgia [ 31 ]. Within bundled payment reimbursement models, healthcare providers are responsible for all costs incurred during an episode of care.…”

Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty

“…Although previous research has described the risks of patients with fibromyalgia receiving total hip and knee arthroplasty, there had still been a lack of literature explicitly covering the disorder's relationship with TSA. 14 , 15 , 17 , 40 - 42 This study characterized the elevated risks of several 90-day complications associated with patients with fibromyalgia undergoing TSA, including infectious, bleeding-related, and venous thromboembolic events, and increased postoperative healthcare utilization.…”

“…The increased risk of infection is in line with previous studies within large, national databases that described the increased risk of UTI, pneumonia, and acute kidney failure for patients with fibromyalgia undergoing either total hip or knee arthroplasty. 40 , 41 , 43 However, the lack of increased risk of revision surgery for patients with fibromyalgia must be considered because postoperative infection often can be an indication for revision surgery. Overall, these data may help guide perioperative decision-making by increasing awareness and suspicion, especially if symptoms begin to develop, of postoperative infection for this patient population.…”