Abstract：
BACKGROUND: The impact of increased patient comorbidities on the cost-effectiveness of total hip arthroplasty (THAs) is lacking. This study aimed to compare revenue, costs, and short-term (90 days) surgical outcomes between patients who have and do not have a high comorbidity burden (HCB).
METHODS: We retrospectively reviewed 14,949 patients who underwent an elective, unilateral THA between 2012 and 2021. Patients were stratified into HCB (Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiology scores of 3 or 4) and non-HCB groups, and were further 1:1 propensity matched based on baseline characteristics. Perioperative data, revenue, costs, and contribution margins (CMs) of the inpatient episode were compared between groups. Also, 90-day readmissions and revisions were compared between groups. Of the 11,717 patients who had available financial data (n = 1,017 HCB, n = 10,700 non-HCB), 1,914 patients were included in the final matched analyses (957 per group).
RESULTS: Total (P < .001) and direct (P < .001) costs were significantly higher for HCB patients. Comparable revenue between cohorts (P = .083) resulted in a significantly decreased CM in the HCB patient group (P < .001). The HCB patients were less likely to be discharged home (P < .001) and had significantly higher 90-day readmission rates (P = .049).
CONCLUSIONS: Increased THA costs for HCB patients were not matched by increased revenue, resulting in decreased CM. Higher rates of nonhome discharge and readmissions in the HCB population add to the additional financial burden. Adjustments to the current reimbursement models should better account for the increased financial burden of HCB patients undergoing THA and ensure access to care for all patient populations.
METHODS: III.
METHODS: We retrospectively reviewed 14,949 patients who underwent an elective, unilateral THA between 2012 and 2021. Patients were stratified into HCB (Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiology scores of 3 or 4) and non-HCB groups, and were further 1:1 propensity matched based on baseline characteristics. Perioperative data, revenue, costs, and contribution margins (CMs) of the inpatient episode were compared between groups. Also, 90-day readmissions and revisions were compared between groups. Of the 11,717 patients who had available financial data (n = 1,017 HCB, n = 10,700 non-HCB), 1,914 patients were included in the final matched analyses (957 per group).
RESULTS: Total (P < .001) and direct (P < .001) costs were significantly higher for HCB patients. Comparable revenue between cohorts (P = .083) resulted in a significantly decreased CM in the HCB patient group (P < .001). The HCB patients were less likely to be discharged home (P < .001) and had significantly higher 90-day readmission rates (P = .049).
CONCLUSIONS: Increased THA costs for HCB patients were not matched by increased revenue, resulting in decreased CM. Higher rates of nonhome discharge and readmissions in the HCB population add to the additional financial burden. Adjustments to the current reimbursement models should better account for the increased financial burden of HCB patients undergoing THA and ensure access to care for all patient populations.
METHODS: III.
摘要：
背景：缺乏患者合并症增加对全髋关节置换术（THA）成本效益的影响。这项研究的目的是比较收入，成本,和短期（90天）手术结局的患者谁有和没有高的合并症负担（HCB）。
方法：我们回顾性分析了14,949例患者，2012年至2021年之间的单边THA。将患者分为HCB组（Charlson合并症指数[CCI]≥5，美国麻醉学学会[ASA]评分为3或4）和非HCB组，并根据基线特征进一步进行1：1的倾向匹配。围手术期数据,收入，成本,两组之间比较了住院患者发作的贡献边缘（CMs）。此外，组间比较90天的再入院和修订。在有财务数据的11,717名患者中(n=1,017名HCB，n=10,700非HCB)，1,914名患者被纳入最终匹配分析（每组957名）。
结果：HCB患者的总费用（P<0.001）和直接费用（P<0.001）明显更高。队列之间的收入比较（P=0.083）导致HCB患者组的CM显着下降（P<0.001）。HCB患者出院的可能性较小（P<0.001），90天再入院率明显较高（P=0.049）结论：HCB患者的THA费用增加与收入增加不匹配，导致CM下降。六氯代苯人口的非家庭出院率和再入院率较高，增加了额外的财政负担。对当前报销模式的调整应更好地考虑到接受THA的HCB患者增加的经济负担，并确保所有患者群体都能获得护理。
方法：我们回顾性分析了14,949例患者，2012年至2021年之间的单边THA。将患者分为HCB组（Charlson合并症指数[CCI]≥5，美国麻醉学学会[ASA]评分为3或4）和非HCB组，并根据基线特征进一步进行1：1的倾向匹配。围手术期数据,收入，成本,两组之间比较了住院患者发作的贡献边缘（CMs）。此外，组间比较90天的再入院和修订。在有财务数据的11,717名患者中(n=1,017名HCB，n=10,700非HCB)，1,914名患者被纳入最终匹配分析（每组957名）。
结果：HCB患者的总费用（P<0.001）和直接费用（P<0.001）明显更高。队列之间的收入比较（P=0.083）导致HCB患者组的CM显着下降（P<0.001）。HCB患者出院的可能性较小（P<0.001），90天再入院率明显较高（P=0.049）结论：HCB患者的THA费用增加与收入增加不匹配，导致CM下降。六氯代苯人口的非家庭出院率和再入院率较高，增加了额外的财政负担。对当前报销模式的调整应更好地考虑到接受THA的HCB患者增加的经济负担，并确保所有患者群体都能获得护理。
