The Economic Impact of Periprosthetic Infections After Total Hip Arthroplasty at a Specialized Tertiary-Care Center

AbstractPatient-reported outcome (PRO) instruments are measures that allow for a standardized assessment of a patient's functional status, symptoms, and quality of life (QoL) through self-reported questionnaires. The purpose of this study was to assess the relationship between PRO scores, which measure patients' preoperative pain and functional status, and discharge disposition in the total hip arthroplasty (THA) population. The authors conducted a retrospective review of patients with a primary diagnosis of osteoarthritis who underwent THA at a single, urban, tertiary care center between September 2013 and August 2016. Patient demographics and preoperative PRO scores (Hip Disability and Osteoarthritis Outcome Score [HOOS] and EuroQol 5-Dimension [EQ-5D] questionnaire) were collected, and discharge disposition was categorized into the following two cohorts: THA recipients discharged to home and those discharged to a postacute care facility. When comparing PRO scores between the two groups, patients discharged home were found to have significantly higher average preoperative global EQ-5D, EQ-5D-QoL, HOOS activities of daily living (ADL), HOOS pain, HOOS sports, and HOOS symptoms scores. Patients discharged home trended toward higher HOOS QoL scores (28.1 vs. 22.6%), but this did not achieve significance (p < 0.08). The authors found a significant relationship between patients' baseline PRO scores and discharge disposition following THA. Patients discharged home had significantly higher preoperative PRO scores as measured by EQ-5D and HOOS. This demonstrates that patients with lower baseline PRO scores, indicating lower baseline function, may require additional care following surgery. These scores provide surgeons with an objective parameter that can assist in the planning and coordination of postoperative care. This study was a level III retrospective cohort.

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The effect of patient point of entry and Medicaid status on quality outcomes following total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1424.r2 ◽

2020 ◽

Vol 102-B (7_Supple_B) ◽

pp. 78-84

Author(s):

Mackenzie A. Roof ◽

James E. Feng ◽

Afshin A. Anoushiravani ◽

Lauren H. Schoof ◽

Scott Friedlander ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Average Length ◽

Care Center ◽

Current Smoker ◽

Quality Outcomes ◽

Total Hip ◽

Discharge Disposition ◽

Point Of Entry ◽

Increased Risk

Aims Previous studies have reported an increased risk for postoperative complications in the Medicaid population undergoing total hip arthroplasty (THA). These studies have not controlled for the surgeon’s practice or patient care setting. This study aims to evaluate whether patient point of entry and Medicaid status plays a role in quality outcomes and discharge disposition following THA. Methods The electronic medical record at our institution was retrospectively reviewed for all primary, unilateral THA between January 2016 and January 2018. THA recipients were categorized as either Medicaid or non-Medicaid patients based on a visit to our institution’s Hospital Ambulatory Care Center (HACC) within the six months prior to surgery. Only patients who had been operated on by surgeons (CML, JV, JDS, RS) with at least ten Medicaid and ten non-Medicaid patients were included in the study. The patients included in this study were 56.33% female, had a mean age of 60.85 years, and had a mean BMI of 29.14. The average length of follow-up was 343.73 days. Results A total of 426 hips in 403 patients were included in this study, with 114 Medicaid patients and 312 non-Medicaid patients. Medicaid patients had a significantly lower mean age (54.68 years (SD 12.33) vs 63.10 years (SD 12.38); p < 0.001), more likely to be black or ‘other’ race (27.19% vs 13.46% black; 26.32% vs 12.82% other; p < 0.001), and more likely to be a current smoker (19.30% vs 9.29%; p = 0.001). After adjusting for patient risk factors, there was a significant Medicaid effect on length of stay (LOS) (rate ratio 1.129, 95% confidence interval (CI) 1.048 to 1.216; p = 0.001) and facility discharge (odds ratio 2.010, 95% CI 1.398 to 2.890; p < 0.001). There was no Medicaid effect on surgical time (exponentiated β coefficient 1.015, 95% CI 0.995 to 1.036; p = 0.136). There was no difference in 30-day readmission, 90-day readmission, 30-day infections, 90-day infections, and 90-day mortality between the two groups. Conclusion After controlling for patient variables, there was a statistically significant Medicaid effect on LOS and facility discharge. These results indicate that clinically similar outcomes can be achieved for Medicaid patients; however, further work is needed on maximizing social support and preoperative patient education with a focus on successful home discharge. Cite this article: Bone Joint J 2020;102-B(7 Supple B):78–84.

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The economic impact of periprosthetic infection in total hip arthroplasty

Canadian Journal of Surgery ◽

10.1503/cjs.004219 ◽

2020 ◽

Vol 63 (1) ◽

pp. E52-E56 ◽

Cited By ~ 4

Author(s):

Jason Akindolire ◽

Mina W. Morcos ◽

Jacquelyn D. Marsh ◽

James L. Howard ◽

Brent A. Lanting ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Economic Impact ◽

Hip Arthroplasty ◽

Periprosthetic Infection ◽

Total Hip

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Two-Stage Revision Total Hip Arthroplasty for Periprosthetic Infections Using Antibiotic-Impregnated Cement Spacers of Various Types and Materials

The Scientific World JOURNAL ◽

10.1155/2013/147248 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Katsufumi Uchiyama ◽

Naonobu Takahira ◽

Kensuke Fukushima ◽

Mitsutoshi Moriya ◽

Takeaki Yamamoto ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Two Stage ◽

Total Hip ◽

Periprosthetic Infections

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The Economic Impact of Minimally Invasive Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2010.09.011 ◽

2011 ◽

Vol 26 (6) ◽

pp. 883-885 ◽

Cited By ~ 9

Author(s):

Paul J. Duwelius ◽

Hans S. Moller ◽

Robert L. Burkhart ◽

Frederick Waller ◽

YingXing Wu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Minimally Invasive ◽

Economic Impact ◽

Hip Arthroplasty ◽

Total Hip

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Impact of body mass on hospital resource use in total hip arthroplasty

Public Health Nutrition ◽

10.1017/s1368980009005072 ◽

2009 ◽

Vol 12 (8) ◽

pp. 1122-1132 ◽

Cited By ~ 26

Author(s):

John A Batsis ◽

James M Naessens ◽

Mark T Keegan ◽

Amy E Wagie ◽

Paul M Huddleston ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Resource Utilization ◽

Hip Arthroplasty ◽

Tertiary Care ◽

Obese Group ◽

Morbidly Obese ◽

Obese Patients ◽

Total Hip ◽

Operative Costs ◽

The Impact

AbstractObjectiveTo determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).DesignA retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).SettingMayo Clinic Rochester, a tertiary care centre.SubjectsPatients were stratified by pre-operative BMI as normal (18·5–24·9 kg/m2), overweight (25·0–29·9 kg/m2), obese (30·0–34·9 kg/m2) and morbidly obese (≥35·0 kg/m2). Of 5642 patients, 1362 (24·1 %) patients had a normal BMI, 2146 (38·0 %) were overweight, 1342 (23·8 %) were obese and 792 (14·0 %) were morbidly obese.ResultsAdjusted LOS was similar among normal (4·99 d), overweight (5·00 d), obese (5·02 d) and morbidly obese (5·17 d) patients (P= 0·20). Adjusted overall episode costs were no different (P= 0·23) between the groups of normal ($17 211), overweight ($17 462), obese ($17 195) and morbidly obese ($17 655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P= 0·03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P< 0·001). Post-operative costs were no different (P= 0·30). Blood bank costs differed (P= 0·002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P< 0·05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24·1 %) than normal (18·4 %), overweight (17·9 %) or obese (16·0 %) patients (P= 0·001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.ConclusionsBMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.

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Health-seeking behavior and the initial economic impact of patients with open globe injuries seeking treatment in a tertiary care center in India

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_3082_20 ◽

2021 ◽

Vol 69 (9) ◽

pp. 2367

Author(s):

MeeraLakshmi Prajna ◽

Ankur Saxena ◽

Ashwin Balasubramanian

Keyword(s):

Economic Impact ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Health Seeking ◽

Health Seeking Behavior ◽

Open Globe ◽

Seeking Behavior ◽

Open Globe Injuries

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Evaluation of results of primary cementless total hip arthroplasty in osteoarthritis

International Surgery Journal ◽

10.18203/2349-2902.isj20170201 ◽

2017 ◽

Vol 4 (2) ◽

pp. 612

Author(s):

Arshad Bashir ◽

Qazi Manan ◽

Faisal Younis Shah ◽

Hayat Ahmad Khan ◽

Mohammad Iqbal Wani ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Disability ◽

Tertiary Care ◽

Hip Osteoarthritis ◽

Harris Hip Score ◽

Total Hip ◽

Cementless Total Hip Arthroplasty ◽

Radiographic Outcomes ◽

Clinical And Radiological Outcome

Background: Total hip arthroplasty involves removal of diseased bone and soft tissue from both femoral and acetabular side and replacing it with mechanical components. It is one of the most successful surgical procedures. It relieves pain and functional disability experienced by patients with moderate to severe osteoarthritis of the hip, improving their quality of life. The success of THA is its ability to relieve the pain, while maintaining both mobility and stability of the joint. The purpose of this study was to evaluate the results of primary cementless total hip arthroplasty in patients with hip osteoarthritis.Methods: This study was done in a tertiary care teaching hospital. Thirty patients with hip osteoarthritis who were treated with cementless total hip arthroplasty were included in the study. This was a prospective study with a minimum of 12 months follow up (maximum of 25 months). The patients’ pre-operative and post-operative pain and functional status was compared using Harris hip score.Results: Excellent or good pain relief and function was obtained in 83.33% of cases. The mean total pre-operative Harris Hip Score was 32.93 which improved to 88.967 post-operatively. There was a statistically significant improvement in all parameters except absence of deformity. The most common complication was persistent anterior thigh pain that occurred in two patients.Conclusions: Our study suggests that the current generation of cementless implants provide satisfactory clinical and radiographic outcomes. Though the study was not free of complications, the overall clinical and radiological outcome showed encouraging results.

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