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...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-05-01
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| Series: | Geriatrics |
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| Online Access: | https://www.mdpi.com/2308-3417/6/2/49 |
| _version_ | 1827692874155687936 |
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| author | Christopher Fang Nicholas Pagani Matthew Gordon Carl T. Talmo David A. Mattingly Eric L. Smith |
| author_facet | Christopher Fang Nicholas Pagani Matthew Gordon Carl T. Talmo David A. Mattingly Eric L. Smith |
| author_sort | Christopher Fang |
| collection | DOAJ |
| 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; <i>p</i> < 0.0001) and were more often privately insured (66.7% vs. 24.2% and 33.9%; <i>p</i> < 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%; <i>p</i> < 0.0001), experienced a longer operating room (OR) time (199.8 min vs. 189.7 min and 172.3 min; <i>p</i> = 0.0195), and had a differing overall hospital length of stay (2.8 days vs. 2.7 days and 3.6 days; <i>p</i> = 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 (<i>p</i> < 0.0001), and 1% and 24% more expensive implant costs (<i>p</i> = 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 (<i>p</i> = 0.185). Multivariate linear regression showed that the implant cost (0.88389; <i>p</i> < 0.0001), OR time (0.12140; <i>p</i> < 0.0001), personnel cost from PACU through to discharge (0.11472; <i>p</i> = 0.0007), and rTHAs (−0.03058; <i>p</i> < 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. |
| first_indexed | 2024-03-10T11:33:02Z |
| format | Article |
| id | doaj.art-ba9f6308294842fba751d03b5805d960 |
| institution | Directory Open Access Journal |
| issn | 2308-3417 |
| language | English |
| last_indexed | 2024-03-10T11:33:02Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Geriatrics |
| spelling | doaj.art-ba9f6308294842fba751d03b5805d9602023-11-21T19:08:44ZengMDPI AGGeriatrics2308-34172021-05-01624910.3390/geriatrics6020049Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age GroupsChristopher Fang0Nicholas Pagani1Matthew Gordon2Carl T. Talmo3David A. Mattingly4Eric L. Smith5New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USADepartment of Orthopaedic Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USADepartment of Orthopaedic Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USANew England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USANew England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USANew England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USAThe 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; <i>p</i> < 0.0001) and were more often privately insured (66.7% vs. 24.2% and 33.9%; <i>p</i> < 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%; <i>p</i> < 0.0001), experienced a longer operating room (OR) time (199.8 min vs. 189.7 min and 172.3 min; <i>p</i> = 0.0195), and had a differing overall hospital length of stay (2.8 days vs. 2.7 days and 3.6 days; <i>p</i> = 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 (<i>p</i> < 0.0001), and 1% and 24% more expensive implant costs (<i>p</i> = 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 (<i>p</i> = 0.185). Multivariate linear regression showed that the implant cost (0.88389; <i>p</i> < 0.0001), OR time (0.12140; <i>p</i> < 0.0001), personnel cost from PACU through to discharge (0.11472; <i>p</i> = 0.0007), and rTHAs (−0.03058; <i>p</i> < 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.https://www.mdpi.com/2308-3417/6/2/49older patientsrevision total hip arthroplastyrevision total knee arthroplastyoctogenariansnonagenariansTDABC |
| spellingShingle | Christopher Fang Nicholas Pagani Matthew Gordon Carl T. Talmo David A. Mattingly Eric L. Smith Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups Geriatrics older patients revision total hip arthroplasty revision total knee arthroplasty octogenarians nonagenarians TDABC |
| 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 | older patients revision total hip arthroplasty revision total knee arthroplasty octogenarians nonagenarians TDABC |
| url | https://www.mdpi.com/2308-3417/6/2/49 |
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