Total Knee Arthroplasty Post Acute Care Costs By Discharge Status

Zeng, Feng; Waldo, Dan

doi:10.1016/j.jval.2016.03.273

Cited by 11 publications

(9 citation statements)

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“…This was illustrated by Zeng and Waldo in a retrospective review entailing 8,801 TKA surgeries. 44 In their study, the authors reported significant increases in 90-day costs for inpatient rehabilitation (þUS $22,921; p < 0.05), skilled nursing facility (þUS$15,489; p < 0.05), and home health care (þUS$6,620; p < 0.05). Similarly, in a retrospective review of 2,328 consecutive TKA recipients, Barad et al 45 revealed that a decrease in mean LOS (2 days to 1.3 days) coupled with an increased discharge to home (9% to 53%) translated to a mean costs savings of US $3,245.…”

Section: Discussionmentioning

confidence: 94%

Cementless versus Cemented Fixation in Total Knee Arthroplasty: Usage, Costs, and Complications during the Inpatient Period

et al. 2018

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Cemented fixation has been the gold standard in total knee arthroplasty (TKA). However, with younger and more active patients requiring TKA, cementless (press-fit) fixation has sparked renewed interest. Therefore, we investigated differences in (1) patient demographics, (2) inpatient costs, (3) short-term complications, and (4) discharge disposition between patients who underwent TKA with cemented and cementless fixation. The National Inpatient Sample database was queried for TKA patients with cement or cementless fixation between October 1 and December 31, 2015. Primary outcomes of interest included complications, length of stay (LOS), discharge disposition, and inpatient costs. Student's t-test and chi-square analysis were used to assess continuous and categorical data, respectively. Multivariable analysis evaluated the effects of fixation type on the continuous and categorical dependent variables. Patients who received cementless fixation were more often younger (63.5 vs. 65.9 years), male (47.4 vs. 40.3%), Black (10.7 vs. 7.7%), from the Northeast census region (29.1 vs. 17.1%), and under private insurance (49.2 vs. 40.3%; p < 0.001 for all). Cementless fixation involved higher inpatient hospital costs (US$17,357 vs. US$16,888) and charges (US$67,366 vs. US$64,190; p < 0.001 for both), lower mean LOS (2.63 vs. 2.71 days; p < 0.001), and higher odds of being discharged to home (odds ratio = 1.99; p = 0.002). This study revisited the outcomes of TKA with cementless fixation and demonstrated higher inpatient charges and costs, shorter mean LOS, and higher odds of being discharged home. Future studies should investigate patient outcomes and complications past the inpatient period, evaluate long-term survivorship and failure rates, and implement a prospective study design.

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Section: Discussionmentioning

confidence: 94%

Cementless versus Cemented Fixation in Total Knee Arthroplasty: Usage, Costs, and Complications during the Inpatient Period

et al. 2018

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“…Preoperative workup d $260 [29][30][31] $260 [29][30][31] $272 [29][30][31] $544 [29][30][31] Anesthesia costs $292 33,38 $292 33,38 $418 33,38 $682 33,38 Surgery/procedure costs $10,785 30,32 $10,785 30,32 $14,024 30,32 $24,809 30,32 Surgeon/proceduralist fee $1,409 30,31 $1,409 30,31 $1,592 30,31 $2,659 30,31 Postoperative care e $101 29,30,35 $101 29,30,35 $101 29,30,35 $4,128 29,30,35 Postacute rehab/physical therapy $6,397 29,34,36,37 $6,397 29,34,36,37 $6,397 29,34,36,37 $16,386 29,34,36,37 Preoperative CT scan -$368 29,30 --…”

Section: Transition Probabilitiesmentioning

confidence: 99%

“…We used Medicare reimbursement schedules to estimate the costs of preoperative office visits, laboratory tests, imaging, inpatient hospital costs, surgeon and anesthesia fees, postoperative care, and rehabilitation [29][30][31][32][33][34][35][36][37][38] (Table 1).…”

Section: Costsmentioning

confidence: 99%

The Cost-Effectiveness of Robotic-Assisted Versus Manual Total Knee Arthroplasty: A Markov Model–Based Evaluation

Rajan

Khlopas²,

Klika³

et al. 2022

J Am Acad Orthop Surg

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Introduction:The purpose of this study was to investigate the costeffectiveness of robotic-assisted total knee arthroplasty (TKA) versus conventional manual TKA in patients with knee osteoarthritis.Methods: A Markov model simulated the lifetime outcomes of TKA of patients at average age 60 years. Costs of robotic-assisted TKA included a preoperative CT scan and the costs for acquisition and use of robotic equipment (average $706,250). We used three institutional case volumes to generate average per-case robotic costs: low volume (10 cases, $71,025 per case), mid volume (100 cases, $7,463 per case), and high volume (200 cases, $3,931 per case). Systematic reviews were used to determine early (#1 year) and late (. 1 year) revision rates after robotic-assisted TKA (0.3 and 0.6%, respectively) and conventional TKA (0.78% and 1.5%, respectively). Outcomes were total costs and health outcomes measured in quality-adjusted life-years (QALYs). Costs and QALYs were organized into incremental cost-effectiveness ratios (ICERs). A procedure was considered costeffective if its ICER fell below willingness-to-pay (WTP) thresholds of $50,000 and $100,000/QALY. Sensitivity analyses evaluated the effect of data uncertainty.Results: Robotic-assisted TKA produced 13.55 QALYs versus 13.29 QALYs for conventional TKA. Total costs per case for robotic-assisted TKA were $92,823 (low volume), $29,261 (mid volume), and $25,730 (high volume) compared with $25,113 for conventional. The ICERs for robotic-assisted TKAs were $256,055/QALY (low volume), $15,685/ QALY (mid volume), and $2,331/QALY (high volume). ICERs for midand high-volume institutions were below WTP. Average number needed to treat was .42 and .24 robotic-assisted TKAs for costeffectiveness at the $50,000 and $100,000/QALY WTP. Roboticassisted TKAs remained cost-effective when annual revision rates ,1.6% and quality of life values were .0.85.

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“…The true cost of these procedures in this patient population includes their post-hospital expenses. A total of 42.8% of the octogenarians and nonagenarian patients needed to be discharged to an SNF, which has been shown to add 15,000 USD in post-acute care costs [27]. Additional healthcare expenditures to care for discharge disposition, readmissions, or complications are not captured in the current study and should be the focus of future research.…”

Section: Discussionmentioning

confidence: 91%

Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

et al. 2021

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The demand for revision total joint arthroplasties (rTJAs) is expected to increase as the age of the population continues to rise. Accurate cost data regarding hospital expenses for differing age groups are needed to deliver optimal care within value-based healthcare (VBHC) models. The aim of this study was to compare the total in-hospital costs by decadal groups following rTJA and to determine the primary drivers of the costs for these procedures. Time-driven activity-based costing (TDABC) was used to capture granular hospital costs. A total of 551 rTJAs were included in the study, with 294 sexagenarians, 198 septuagenarians, and 59 octogenarians and older. Sexagenarians had a lower ASA classification (2.3 vs. 2.4 and 2.7; p < 0.0001) and were more often privately insured (66.7% vs. 24.2% and 33.9%; p < 0.0001) as compared to septuagenarians and octogenarians and older, respectively. Sexagenarians were discharged to home at a higher rate (85.3% vs. 68.3% and 34.3%; p < 0.0001), experienced a longer operating room (OR) time (199.8 min vs. 189.7 min and 172.3 min; p = 0.0195), and had a differing overall hospital length of stay (2.8 days vs. 2.7 days and 3.6 days; p = 0.0086) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had 7% and 23% less expensive personnel costs from post-anesthesia care unit (PACU) to discharge (p < 0.0001), and 1% and 24% more expensive implant costs (p = 0.077) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had a lower total in-hospital cost for rTJAs by 0.9% compared to septuagenarians but 12% more expensive total in-hospital costs compared to octogenarians and older (p = 0.185). Multivariate linear regression showed that the implant cost (0.88389; p < 0.0001), OR time (0.12140; p < 0.0001), personnel cost from PACU through to discharge (0.11472; p = 0.0007), and rTHAs (−0.03058; p < 0.0001) to be the strongest associations with overall costs. Focusing on the implant costs and OR times to reduce costs for all age groups for rTJAs is important to provide cost-effective VBHC.

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Total Knee Arthroplasty Post Acute Care Costs By Discharge Status

Cited by 11 publications

References 0 publications

Cementless versus Cemented Fixation in Total Knee Arthroplasty: Usage, Costs, and Complications during the Inpatient Period

Cementless versus Cemented Fixation in Total Knee Arthroplasty: Usage, Costs, and Complications during the Inpatient Period

The Cost-Effectiveness of Robotic-Assisted Versus Manual Total Knee Arthroplasty: A Markov Model–Based Evaluation

Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

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