Abstract：
BACKGROUND: The clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tertiary health system.
METHODS: This is a retrospective review of 2,101 THAs (1,092 P and 1,009 DA) by 4 surgeons (2 with the highest volume of DA and P, respectively) from 2017 to 2022 at 1 academic center. Demographics, comorbidities, operative time, length of hospital stay, 90-day hospital returns, and complications were compared. The total encounter cost and 90-day postoperative cost were itemized. Multivariable regression analyses evaluated associations with increased cost at each time point.
RESULTS: The DA cohort had a higher median encounter cost ($8,348.66 versus 7,332.42, P < .01), resulting from higher intraoperative (P < .01) and radiology (P < .01) expenses. Regression analyses demonstrated the DA was independently associated with increased encounter costs (odds ratio 1.1; 95% confidence interval 1.1 to 1.1; P < .01). There was a higher incidence of 90-day emergency department visits in the DA cohort (16 versus 12%, P = .02), with a trend toward increased readmissions. There was no difference in 90-day reoperations. Median 90-day cost was higher in the DA cohort ($126.99 versus 0.00, P < .01), and regression analyses demonstrated the DA had an association with increased 90-day cost (odds ratio 2.2; 95% confidence interval 1.5 to 3.0; P < .01).
CONCLUSIONS: Despite a younger patient population, the DA was independently associated with increased encounter and 90-day costs in a single academic hospital system. This study may underestimate the cost difference, as capital costs such as specialized tables were not analyzed.
METHODS: This is a retrospective review of 2,101 THAs (1,092 P and 1,009 DA) by 4 surgeons (2 with the highest volume of DA and P, respectively) from 2017 to 2022 at 1 academic center. Demographics, comorbidities, operative time, length of hospital stay, 90-day hospital returns, and complications were compared. The total encounter cost and 90-day postoperative cost were itemized. Multivariable regression analyses evaluated associations with increased cost at each time point.
RESULTS: The DA cohort had a higher median encounter cost ($8,348.66 versus 7,332.42, P < .01), resulting from higher intraoperative (P < .01) and radiology (P < .01) expenses. Regression analyses demonstrated the DA was independently associated with increased encounter costs (odds ratio 1.1; 95% confidence interval 1.1 to 1.1; P < .01). There was a higher incidence of 90-day emergency department visits in the DA cohort (16 versus 12%, P = .02), with a trend toward increased readmissions. There was no difference in 90-day reoperations. Median 90-day cost was higher in the DA cohort ($126.99 versus 0.00, P < .01), and regression analyses demonstrated the DA had an association with increased 90-day cost (odds ratio 2.2; 95% confidence interval 1.5 to 3.0; P < .01).
CONCLUSIONS: Despite a younger patient population, the DA was independently associated with increased encounter and 90-day costs in a single academic hospital system. This study may underestimate the cost difference, as capital costs such as specialized tables were not analyzed.
摘要：
背景：手术方法在全髋关节置换术（THA）中的临床影响已得到广泛综述。这项研究评估了一个三级卫生系统中两种手术方法（后[P]和直接前[DA]）的THA的总遭遇和90天费用。
方法：这是四位外科医生对2,101THA（1,092P和1,009DA）的回顾性审查（其中两位DA和P的体积最高，分别)从2017年到2022年在一个学术中心。人口统计,合并症,手术时间,停留时间(LOS)90天医院复诊,并对并发症进行比较。详细列出了总的遭遇费用和术后90天的费用。多变量回归分析评估了每个时间点与成本增加的关联。
结果：DA队列的中位相遇成本较高（$8,348.66对7,332.42，P<0.01），由于术中（P<0.01）和放射学（P<0.01）费用较高。回归分析显示DA与增加的遭遇费用独立相关(OR[比值比]1.1;95%CI[置信区间]1.1至1.1;P<0.01)。DA队列中90天急诊科（ED）就诊的发生率较高（16对12％，P=0.02),有增加再入院的趋势。90天的再手术没有差异。DA队列的90天成本中位数较高（$126.99vs0.00，P<0.01），回归分析显示,DA与90天费用增加相关(OR2.2;95%CI1.5~3.0;P<0.01).
结论：尽管患者群体较年轻，在单一的学术医院系统中,DA与增加的见面会和90天的费用独立相关.这项研究可能低估了成本差异，因为没有分析专门表格等资本成本。
方法：这是四位外科医生对2,101THA（1,092P和1,009DA）的回顾性审查（其中两位DA和P的体积最高，分别)从2017年到2022年在一个学术中心。人口统计,合并症,手术时间,停留时间(LOS)90天医院复诊,并对并发症进行比较。详细列出了总的遭遇费用和术后90天的费用。多变量回归分析评估了每个时间点与成本增加的关联。
结果：DA队列的中位相遇成本较高（$8,348.66对7,332.42，P<0.01），由于术中（P<0.01）和放射学（P<0.01）费用较高。回归分析显示DA与增加的遭遇费用独立相关(OR[比值比]1.1;95%CI[置信区间]1.1至1.1;P<0.01)。DA队列中90天急诊科（ED）就诊的发生率较高（16对12％，P=0.02),有增加再入院的趋势。90天的再手术没有差异。DA队列的90天成本中位数较高（$126.99vs0.00，P<0.01），回归分析显示,DA与90天费用增加相关(OR2.2;95%CI1.5~3.0;P<0.01).
结论：尽管患者群体较年轻，在单一的学术医院系统中,DA与增加的见面会和90天的费用独立相关.这项研究可能低估了成本差异，因为没有分析专门表格等资本成本。
