Cargando…

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

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 s...

Descripción completa

Detalles Bibliográficos
Autores principales: Fang, Christopher, Pagani, Nicholas, Gordon, Matthew, Talmo, Carl T., Mattingly, David A., Smith, Eric L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162336/
https://www.ncbi.nlm.nih.gov/pubmed/34064743
http://dx.doi.org/10.3390/geriatrics6020049
_version_ 1783700689616109568
author Fang, Christopher
Pagani, Nicholas
Gordon, Matthew
Talmo, Carl T.
Mattingly, David A.
Smith, Eric L.
author_facet Fang, Christopher
Pagani, Nicholas
Gordon, Matthew
Talmo, Carl T.
Mattingly, David A.
Smith, Eric L.
author_sort Fang, Christopher
collection PubMed
description 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.
format Online
Article
Text
id pubmed-8162336
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-81623362021-05-29 Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups Fang, Christopher Pagani, Nicholas Gordon, Matthew Talmo, Carl T. Mattingly, David A. Smith, Eric L. Geriatrics (Basel) Article 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. MDPI 2021-05-11 /pmc/articles/PMC8162336/ /pubmed/34064743 http://dx.doi.org/10.3390/geriatrics6020049 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Fang, Christopher
Pagani, Nicholas
Gordon, Matthew
Talmo, Carl T.
Mattingly, David A.
Smith, Eric L.
Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups
title Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups
title_full Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups
title_fullStr Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups
title_full_unstemmed Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups
title_short Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups
title_sort episode-of-care costs for revision total joint arthroplasties by decadal age groups
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162336/
https://www.ncbi.nlm.nih.gov/pubmed/34064743
http://dx.doi.org/10.3390/geriatrics6020049
work_keys_str_mv AT fangchristopher episodeofcarecostsforrevisiontotaljointarthroplastiesbydecadalagegroups
AT paganinicholas episodeofcarecostsforrevisiontotaljointarthroplastiesbydecadalagegroups
AT gordonmatthew episodeofcarecostsforrevisiontotaljointarthroplastiesbydecadalagegroups
AT talmocarlt episodeofcarecostsforrevisiontotaljointarthroplastiesbydecadalagegroups
AT mattinglydavida episodeofcarecostsforrevisiontotaljointarthroplastiesbydecadalagegroups
AT smithericl episodeofcarecostsforrevisiontotaljointarthroplastiesbydecadalagegroups