背景:全膝关节置换术(TKA)通常被认为是治疗对症限制性膝骨关节炎。随着利用率的提高,了解可变性和相关的驱动因素可能有助于医疗保健系统优化对大量患者的交付。
方法:从2010年至2021年PearlDiver国家数据集中,共分离出1,066,327例接受原发性TKA的TKA患者。排除标准包括未满18岁且有创伤的患者,传染性,或肿瘤适应症。总的来说,90天报销和与患者相关的变量,外科手术,区域,并提取围手术期。进行多变量线性回归以确定报销的独立驱动因素。
结果:术后90天的报销平均(标准偏差)为$11,212.99($15,000.62),中位数(四分位数间距)为4,472.00美元(13,101.00美元),和总计11,946,962,912美元。与总体90天报销的最大增加独立相关的变量与入院有关(患者索引程序[5,695.26美元]或再次住院[18,495.03美元])。进一步的驱动因素是地区(中西部+8,826.21美元,西部+4,578.55美元,南部+3,709.40美元;相对于东北部),保险(商业+4,492.34美元,医疗补助+1,187.65美元;相对于医疗保险),术后急诊就诊(+$3,574.57),术后不良事件(+$1,309.35),(每个P<.0001)。
结论:当前的研究评估了超过一百万的TKA患者,发现报销/费用差异很大。报销的最大增加与入院(再入院或索引程序)有关。其次是区域,保险,和其他术后事件。这些结果强调了在适当患者中进行门诊手术与再入院风险之间取得平衡的必要性,并定义了成本控制策略的其他领域。
Total knee arthroplasty (TKA) is commonly considered to address symptomatically limiting knee osteoarthritis. With increasing utilization, understanding the variability and related drivers may help the healthcare system optimize delivery to the large numbers of patient to whom it is offered.
A total of 1,066,327 TKA patients who underwent primary TKA were isolated from a 2010 to 2021
PearlDiver national dataset. Exclusion criteria included patients less than 18 years old and traumatic, infectious, or oncologic indications. Overall, 90-day reimbursements and variables associated with the patient, surgical procedure, region, and perioperative period were abstracted. Multivariable linear regressions were performed to determine independent drivers of reimbursement.
The 90-day postoperative reimbursements had an average (standard deviation) of $11,212.99 ($15,000.62), a median (interquartile range) of $4,472.00 ($13,101.00), and a total of $11,946,962,912. Variables independently associated with the greatest increase in overall 90-day reimbursement were related to admission (in-patient index-procedure [+$5,695.26] or hospital readmission [+$18,495.03]). Further drivers were region (Midwest +$8,826.21, West +$4,578.55, South +$3,709.40; relative to Northeast), insurance (commercial +$4,492.34, Medicaid +$1,187.65; relative to Medicare), postoperative emergency department visits (+$3,574.57), postoperative adverse events (+$1,309.35), (P < .0001 for each).
The current study assessed over a million TKA patients and found large variations in reimbursement/cost. The largest increases in reimbursement were associated with admission (readmission or index procedure). This was followed by region, insurance, and other postoperative events. These results underscore the necessity to balance performing out-patient surgeries in appropriate patients versus the risk of readmissions and defined other areas for cost containment strategies.