Abstract Introduction The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid services (CMS) program designed to promote coordinated and efficient care. This ...study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee or hip arthroplasty (TKA or THA). Methods From January 2013 through December 2013 one urban, tertiary, academic orthopaedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital (OSH) within 90-days from the index episode were identified. The diagnosis and cost for each readmission was analyzed. Results Eighty readmissions in 69 patients (11%) were identified within 90-days. There were 53 readmissions (45 patients) following THA, and 27 readmissions (24 patients) following TKA. Surgical complications accounted for 54% of THA readmissions and 44% TKA readmissions. These complications had an average cost of $36,038 (range $6,375-$60,137) for THA and $38,953 (range $4,790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range $5,678-$82,940) for THA and $24,183 (range $3,306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Conclusion Hospital readmissions following THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts.
Abstract Background Revision total hip arthroplasty (RHA) has been associated with greater morbidity and length of stay (LOS) compared to primary total hip arthroplasty. Despite this, few validated ...metrics exist for risk stratification in RHA cohorts. The Charlson Comorbidity Index (CCI) has been associated with complications in total hip arthroplasty, but its utility in revision surgery remains unexplored. The purpose of this study was to examine the relationship between preoperative CCI and a variety of outcome metrics following RHA. Methods The National Surgical Quality Improvement Program database was used to identify all patients undergoing aseptic RHA between 2006 and 2013. A variety of demographics and perioperative variables were collected. Modified CCI scores were computed for each patient based on a validated formula incorporating comorbidities found in the National Surgical Quality Improvement Program database. Outcome variables of interest included mortality, major postoperative complications, minor adverse events, incidence of transfusion, and prolonged LOS. Perioperative factors were tested for association with these outcomes using bivariate analysis and significant variables were then incorporated into a logistic regression model to explore the relationship between preoperative CCI scores and postoperative events. Results In a multivariable regression model controlling for the significant perioperative variables, operative time, and American Society of Anesthesiologists classification, higher CCI scores were significantly associated with mortality (odds ratio OR 1.89, 95% confidence interval CI 1.64-2.18, P < .001), major complications (OR 1.12, 95% CI 1.05-1.20, P = .001), minor complications (OR 1.53, 95% CI 1.39-1.69, P < .001), transfusions (OR 1.14, 95% CI 1.09-1.20, P < .001), and prolonged LOS (OR 1.32, 95% CI 1.26-1.39, P < .001). Conclusion Higher preoperative CCI scores were independent risk factors for numerous complications. This highlights the potential utility of the CCI in risk stratification for RHA populations.
Abstract There is currently wide variation in the use and cost of post acute care following total joint arthroplasty. Additionally the optimum setting to which patients should be discharged after ...surgery is controversial. Discharge patterns following joint replacement vary widely between physicians at our institution, however, only weak correlations were found between the cost of discharge and length of stay or readmission rates. The inter-physician variance in discharge cost did not correlate to a difference in quality, as measured by length of stay and readmission rates, but does imply there is significant opportunity to modify physician discharge practices without impacting patient outcomes and the quality of care.
Abstract We explored the average cost of 94,197 total knee and 78,541 total hip arthroplasties (TKA and THA) using the New York State Hospital Inpatient Cost Transparency database to evaluate the ...effect of beneficiary health status on hospital reported cost for the two operations. Using the 3M APR-DRG severity of illness index as a measure of patient's health status, we found a significant increase in cost for both TKA and THA for patients with higher severity of illness index. This study confirms the greater cost and variability of TKA and THA for patients with increased severity of illness and illustrates the inherent unpredictability in cost forecasting and budgeting for these same patients.
