Dataset Information

Perioperative Operating Room Efficiency Can Make Simultaneous Bilateral Total Hip Arthroplasty Cost-effective: A Proposal for a Value-sharing Model.

ABSTRACT:

Background

Increasing demand for total hip arthroplasty (THA) and rising health-care costs have led hospitals to improve operating room (OR) efficiency. We compare the cost-effectiveness of a simultaneous bilateral THA to that of staged unilateral procedures following the implementation of OR efficiency strategies.

Methods

Between 2017 and 2019, 446 simultaneous and 238 staged bilateral primary THA patients (mean age 61.3 ± 12.0 years; 41.8% males/58.2% females; mean body mass index 27.2 ± 4.8 kg/m²) were treated by a single surgeon using an efficient, standardized workflow for efficient direct anterior approach THA on a standard operating table. There were no differences in inclusion criteria between both groups. From this cohort, 16 simultaneous bilateral THAs and 34 unilateral THAs were prospectively compared for cost-effectiveness using detailed timestamp measurements and data on personnel and material usage. Outcome was assessed based on complication and reoperation rate and patient-reported outcome measures.

Results

There was a complication rate of 1.2%, without a difference between patients who underwent a simultaneous THA vs those who underwent a staged primary THA (5/446; 1.1% vs 3/238; 1.3% P = .386). The mean OR time (patient in/out and turnover time) was 109.4 ± 19.8 minutes for bilateral THAs and 133.8 ± 12.8 minutes for 2 unilateral THAs (P < .001). An 18% time-saving and 14% cost-saving was achieved per procedure. Sharing 5% of the cost-saving with the surgeon brings benefit to both the hospital and surgeon.

Conclusions

Implementing OR efficiency improves cost-effectiveness of simultaneous bilateral THA compared to unilateral procedures. A new value-sharing model could be a solution to align incentives.

SUBMITTER: Verhaegen JCF

PROVIDER: S-EPMC9764026 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Perioperative Operating Room Efficiency Can Make Simultaneous Bilateral Total Hip Arthroplasty Cost-effective: A Proposal for a Value-sharing Model.

Verhaegen Jeroen C F JCF Schreiber Alexina A Balust Clara C Menon Ayishwariya A Dille Jeroen J Corten Kristoff K

Arthroplasty today 20221102

<h4>Background</h4>Increasing demand for total hip arthroplasty (THA) and rising health-care costs have led hospitals to improve operating room (OR) efficiency. We compare the cost-effectiveness of a simultaneous bilateral THA to that of staged unilateral procedures following the implementation of OR efficiency strategies.<h4>Methods</h4>Between 2017 and 2019, 446 simultaneous and 238 staged bilateral primary THA patients (mean age 61.3 ± 12.0 years; 41.8% males/58.2% females; mean body mass ind ...[more]

PMID: 36561552

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Project description:ObjectiveTo assess the efficacy and safety of hypotensive anesthesia (HA) combined with tranexamic acid (TXA) for reducing perioperative blood loss in simultaneous bilateral total hip arthroplasty (SBTHA).MethodsIn this retrospective cohort study, a total of 183 eligible patients (15 females and 168 males, 44.01 ± 9.29 years old) who underwent SBTHA from January 2015 to September 2020 at our medical center were enrolled for analysis. Fifty-nine patients received standard general anesthesia (Std-GA group), the other 85 and 39 patients received HA with an intraoperative mean arterial pressure between 70 and 80 mmHg (70-80 HA group) and below 70 mmHg (<70 HA group), respectively. TXA was administrated to all patients. Perioperative blood loss (total, dominant, and hidden), transfusion rate and volume, hemoglobin and hematocrit reduction, duration of operation and anesthesia, length of hospitalization, range of hip motion as well as postoperative complications were collected from hospital's electronic records and compared between groups.ResultsAll patients were followed for more than 3 months. Total blood loss in the two HA groups (1390.25 ± 595.67 ml and 1377.74 ± 423.46 ml, respectively) was significantly reduced compared with that in Std-GA group (1850.83 ± 800.73 ml, P < 0.001). Both dominant and hidden blood loss were dramatically decreased when HA was applied (both P < 0.001). Accordingly, the transfusion rate along with volume in 70-80 HA group (14.1%, 425.00 ± 128.81 ml) and <70 HA group (12.8%, 340.00 ± 134.16 ml) were reduced in comparison with those in Std-GA group (37.3%, 690.91 ± 370.21ml; P = 0.001 and P = 0.014, respectively). The maximal hemoglobin and hematocrit reduction in both HA groups were significantly less than those in Std-GA group (both P < 0.001). Of note, 70-80 and <70 HA groups exhibited comparable efficacy with no significant differences between them. Besides, significant difference in duration of surgery was found among groups (P = 0.044 and P < 0.001), while no differences in anesthesia time and postoperative range of hip motion were observed. Regarding complications, the incidence of both acute kidney injury and postoperative hypotension in <70 HA group was significantly higher than that in 70-80 HA and Std-GA groups (P = 0.014 and P < 0.001). Incidence of acute myocardial injury was similar among groups (P = 0.099) and no other severe complications or mortality were recorded.ConclusionThe combination of HA with a mean arterial pressure (MAP) of 70-80 mmHg and TXA could significantly reduce blood loss and transfusion during SBTHA, in addition to shortening operation time and length of hospitalization, and with no increase in complications.

Dataset Information

Perioperative Operating Room Efficiency Can Make Simultaneous Bilateral Total Hip Arthroplasty Cost-effective: A Proposal for a Value-sharing Model.

Background

Methods

Results

Conclusions

Publications

Perioperative Operating Room Efficiency Can Make Simultaneous Bilateral Total Hip Arthroplasty Cost-effective: A Proposal for a Value-sharing Model.

Similar Datasets

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