Dataset Information

[The costs of preoperative anemia in hip joint revision surgery].

ABSTRACT:

Background

Anemia is highly prevalent in patients before hip joint revision surgery (HJRS) and is associated with an increased complication rate. This paper is the first to investigate costs, real diagnosis-related group (DRG) revenues and case coverage of preoperative anemia in elective HJRS.

Methods

Medical data, transfusions, costs, and revenues of all patients undergoing HJRS at two campuses of the Charité -Universitätsmedizin Berlin between 2010 and 2017 were used for subgroup analyses and linear regressions.

Results

Of 1187 patients included 354 (29.8%) showed preoperative anemia. A total of 565 (47.6%) patients were transfused with a clear predominance of anemic patients (72.6% vs. 37.0%, p < 0.001). Costs (12,318€ [9027;20,044€] vs. 8948€ [7501;11,339€], p < 0.001) and revenues (11,788€ [8992;16,298€] vs. 9611€ [8332;10,719€], p < 0.001) were higher for preoperatively anemic patients and the coverage was deficient (-1170€ [-4467;1238€] vs. 591€ [-1441;2103€], p < 0.001). In anemic patients, case contribution margins decreased with increasing transfusion rates (p ≤ 0.001). Comorbidities had no significant economic impact.

Conclusion

Preoperative anemia and perioperative transfusions in HJRS are associated with increased treatment costs and a financial undercoverage for healthcare providers and health insurance companies. Concepts for the treatment of preoperative anemia (e.g. patient blood management) could reduce treatment costs in the medium term.

SUBMITTER: Vorderwulbecke G

PROVIDER: S-EPMC9852200 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

[The costs of preoperative anemia in hip joint revision surgery].

Vorderwülbecke Gerald G Spies Claudia C von Heymann Christian C Kruppa Jochen J Fürstenau Daniel D Kaufner Lutz L Werner Sven S Höft Moritz M Balzer Felix F

Die Anaesthesiologie 20221115 1

<h4>Background</h4>Anemia is highly prevalent in patients before hip joint revision surgery (HJRS) and is associated with an increased complication rate. This paper is the first to investigate costs, real diagnosis-related group (DRG) revenues and case coverage of preoperative anemia in elective HJRS.<h4>Methods</h4>Medical data, transfusions, costs, and revenues of all patients undergoing HJRS at two campuses of the Charité -Universitätsmedizin Berlin between 2010 and 2017 were used for subgrou ...[more]

PMID: 36378326

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Project description:Background Two-stage revision arthroplasty is the gold standard for treating chronic prosthetic joint infection (PJI), but there has been limited analysis of the costs incurred beyond the index procedure and how additional complications and/or surgeries impact the cost of care. Methods The electronic health record was queried for patients who underwent a total hip arthroplasty complicated by PJI and then underwent removal of the prosthesis with implantation of an antibiotic-impregnated articulating cement spacer. Patient demographics, surgical variables, hospital readmissions, emergency department (ED) visits, and postoperative complications were recorded. Data on total costs were collected with an internal accounting database. The average follow-up duration was 3.35 years. Results Univariate analyses showed statistically significant differences between outcome groups (reimplantation, reimplantation requiring later revision, retained spacer, and Girdlestone resection arthroplasty) in total overall costs, ED visit costs, and postoperative costs at 1 and 2 years after the initial spacer placement. The median total cost at 2 years for each group was $38,865 ($29,144-49,471) (reimplantation), $79,223 ($53,442-100,152) (reimplantation with revision), $54,096 ($20,872-73,903) (retained spacer), $62,134 ($52,135-101,546) (Girdlestone). Patients who underwent successful reimplantation requiring no further surgery had significantly lower total costs than patients who needed revision surgeries after reimplantation ($38,865 [$29,144-49,471] vs $79,223 [$53,442-100,152], P = .007). Patients with a Girdlestone resection arthroplasty had higher total costs at 1 year ($59,708 [$41,781-80,916] vs $33,093 [$27,237-40,429], P = .043) and higher costs attributable to ED visits at 2 years than the reimplantation group ($23,581 [$14,029-41,519] vs $15,307 [$6291-29,119], P = .009). Conclusions A significant variation exists among total costs for the 2-stage treatment of hip PJI when stratified by the final outcome.

Project description:BackgroundHip and knee arthroplasties are common and successful procedures, however, success and durability are not guaranteed. The revision burden, defined as the ratio of implant revisions to the total number of arthroplasties in a specific period, is a measure of the steady state of arthroplasty success in a given registry. This study examines the hypothesis that revision burden would be similar among contemporary joint replacement registries and improving over time compared with historic controls.MethodsWe evaluated the national joint registries of 5 health systems (Australian Orthopaedic Association National Joint Replacement Registry [AOANJRR]; National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man; New Zealand Joint Registry [NZJR]; Swedish Hip Arthroplasty Register [SHAR] and Swedish Knee Arthroplasty Register [SKAR]; and the American Joint Replacement Registry [AJRR]) for hip and knee revision burden over the past 4 years or since registry inception. Historic controls were obtained from previously published reports.ResultsThe 2014 hip revision burden varied from 9.7 percent (NJR) to 11.9 percent (NZJR), and the unweighted average was 10.4 percent. The 2011, 2012, and 2013 mean hip revision burden was 11.9, 11.9, and 11.4 percent. The 2014 knee revision burden varied from to 6.0 percent (NJR) to 8.1 percent (AJRR), and the unweighted average for the 5 registries studied was 7.0 percent. The 2011, 2012, and 2013 mean knee revision burden was 6.9, 7.0, and 7.0 percent. Historically, the observed hip revision burden was 15.8 percent and the knee revision burden 8.0 percent.ConclusionsRevision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.

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Dataset Information

[The costs of preoperative anemia in hip joint revision surgery].

Background

Methods

Results

Conclusion

Publications

[The costs of preoperative anemia in hip joint revision surgery].

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