scholarly journals Significant cost savings and similar patient outcomes associated with early discharge following total knee arthroplasty

2019 ◽  
Vol 62 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Jacquelyn Marsh ◽  
Lyndsay Somerville ◽  
James L. Howard ◽  
Brent A. Lanting
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
Cost Savings ◽  
Early Discharge ◽  
Significant Cost ◽  
Similar Patient ◽  
Total Knee

scholarly journals Effect of Hospital and Surgeon Volume on Hospital Costs for Total Knee Arthroplasty

2021 ◽  
Author(s):  
YECHU HUA ◽  
Caroline Thirukumaran ◽  
Yue Li
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
Hospital Volume ◽  
Cost Savings ◽  
High Volume ◽  
Surgeon Volume ◽  
Inpatient Cost ◽  
Total Knee ◽  
Low Volume

Abstract Purpose: Higher hospital or surgeon volume is shown to be associated with better patient outcomes following primary total knee arthroplasty (TKA). However, little research exists on the relationship between hospital and surgeon volume and inpatient costs of TKA. To explore the volume-cost relationship for primary TKA and to determine whether both hospital volume and surgeon volume are independently associated with lower inpatient costs. Methods: Statewide Planning and Research Cooperative System (SPARCS) claims data from the New York State Department of Health were used to identify 102,386 adults who underwent primary TKA from 2013 to 2016. Surgeon volume was defined as the number of TKA cases a surgeon had operated during the previous 365 days of the current case. Hospital volume was defined in a similar way. Hospital and surgeon volumes were categorized as tertile groups. Generalized linear models adjusted for patient, hospital, surgeon, and market covariates.Main Outcome Measures: Inpatient cost calculated as total charges multiplied by cost-to-charge ratios (CCR) and adjusted for inflation.Results: Compared with patients operated by low-volume surgeons in low-volume hospitals, patients of high-volume surgeons in high-volume hospitals had significantly lower inpatient costs (adjusted cost savings = $3,384 per TKA case, 95% confidence interval $3,184 - $3,583, P < 0.001). The inverse volume-cost relationship tended to be stronger in more recent years.Conclusions: TKAs performed at hospitals and by surgeons with higher volumes had significantly lower inpatient costs, especially in more recent years. Regionalization of TKA to high-volume hospitals and surgeons may achieve both better patient outcomes and cost savings.

Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Thomas A. Novack ◽  
Christopher J. Mazzei ◽  
Jay N. Patel ◽  
Eileen B. Poletick ◽  
Roberta D'Achille ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Care Pathway ◽  
Primary Total Knee Arthroplasty ◽  
Cost Savings ◽  
Patient Discharge ◽  
Control Group ◽  
Study Group ◽  
Bundled Payment ◽  
Total Knee

AbstractSince the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.

scholarly journals Does surgical approach affect patient outcomes of total knee arthroplasty?

2021 ◽  
Vol 64 (5) ◽  
pp. E521-E526
Author(s):  
Sahil Prabhnoor Sidhu ◽  
Lyndsay E. Somerville ◽  
Aamir Sohail Sidhu ◽  
Ryan T. Willing ◽  
Matthew G. Teeter ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
Surgical Approach ◽  
Total Knee

Costs of unicompartmental compared with total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 23-31
Author(s):  
Robert A. Burnett III ◽  
JaeWon Yang ◽  
P. Maxwell Courtney ◽  
E. Bailey Terhune ◽  
Charles P. Hannon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Healthcare Costs ◽  
Cost Savings ◽  
Vein Thrombosis ◽  
Total Knee ◽  
The Mean ◽  
One Year ◽  
Surgery Rates

Aims The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. Results Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). Conclusion Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.

The Effect of Polyethylene Liner Thickness on Patient Outcomes and Failure After Primary Total Knee Arthroplasty

2020 ◽  
Vol 35 (8) ◽  
pp. 2072-2075
Author(s):  
Simon P. Garceau ◽  
Yaniv S. Warschawski ◽  
Alex Tang ◽  
Ethan B. Sanders ◽  
Ran M. Schwarzkopf ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Polyethylene Liner ◽  
Total Knee ◽  
Primary Total Knee

Narcotic-Free Perioperative Total Knee Arthroplasty: Does the Periarticular Injection Medication Make a Difference?

2019 ◽  
Author(s):  
J. Schneider ◽  
B. Broome ◽  
D. Keeley
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Knee Arthroplasty ◽  
Management Strategies ◽  
Perioperative Period ◽  
High Variability ◽  
Cost Difference ◽  
Significant Cost ◽  
Total Knee ◽  
To Receive

AbstractMultimodal pain management strategies are critical in total knee arthroplasty (TKA). There has recently been a shift toward opioid sparing protocols, yet most publications continue to use narcotics in the perioperative period. Periarticular injections are a popular adjunct but studies regarding the optimal medications have high variability making it difficult to choose the optimal medication. The purpose of this study is to validate a perioperative, opioid-free protocol and compare two different periarticular injections without the variability in previous reports. A multimodal pain protocol was instituted that administered no narcotic medications in the perioperative period. Over 2 years, primary TKA patients were informally randomized to receive liposomal bupivacaine (LB), or a cocktail of medications (CO). A total of 189 patients were included: 101 patients in group LB and 88 patients in group CO. Postoperative opioid consumption, length of stay, and inpatient distance ambulated were compared across the two injection groups. In morphine milligram equivalents, group LB consumed a mean of 20.36 mg of oxycodone versus 23.18 mg in group CO (p = 0.543). For tramadol, group LB consumed 27.24 mg versus 28.69 mg in group CO (p = 0.714). Mean hospital stay was 1.70 days for group LB and 1.72 days for group CO (p = 0.811). Distance ambulated was 528.4ft for group LB and 499.8ft for group CO (p = 0.477). In the LB group, 50% of patients required no oxycodone, and 12% of them took neither oxycodone nor tramadol for pain. In the CO group, 40% declined oxycodone and 10% declined both oxycodone and tramadol. We successfully treated all patients without narcotic medications in the perioperative period. Although we saw trends for improvements in group LB, these were small and not clinically meaningful. It appears that both injections were effective. There is a significant cost difference and medications should be chosen based on surgeon preference and institutional needs.

All-Polyethylene versus Metal-Backed Tibial Components in Total Knee Arthroplasty

2019 ◽  
Vol 32 (08) ◽  
pp. 714-718 ◽  
Author(s):  
Samuel AbuMoussa ◽  
Charles Cody White ◽  
Josef K. Eichinger ◽  
Richard J. Friedman
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
Gold Standard ◽  
Implant Design ◽  
Economic Strain ◽  
The Past ◽  
Backside Wear ◽  
Total Knee ◽  
Dynamic Shift

AbstractAll-polyethylene tibial (APT) implants were incorporated into the initial design of the first total knee arthroplasty (TKA) systems. Since then, a dynamic shift has taken place and metal-backed tibial (MBT) implants have become the gold standard in TKA. This has mostly been due to the theoretical advantages of intraoperative flexibility and improved biomechanics in addition to the heavy influence of device manufacturers. MBT implant comes not only with a higher cost but also with potential for complications such as osteolysis, backside wear, and thinning of the polyethylene insert, which were not previously seen with APT implant. The majority of studies comparing APT and MBT implants have shown no difference in clinical outcomes and survivorship. Newer studies from the past decade have begun highlighting the economic advantages of APT implant, especially in patients undergoing primary, uncomplicated TKA. Use of APT implants in younger patients and those with a body mass index > 35 has not been extensively studied, but the existing literature suggests the use of APT implant in these cohorts to be equally as acceptable. With modern implant design and instrumentation, rising utilization of TKA along with current and future economic strain on health care, the increased use of APT implant could result in massive savings without sacrificing positive patient outcomes.

Template-directed Instrumentation in Total Knee Arthroplasty: Cost Savings Analysis

Orthopedics ◽  
2012 ◽  
Vol 35 (11) ◽  
pp. e1596-e1600 ◽  
Author(s):  
Andrew R. Hsu ◽  
Christopher E. Gross ◽  
Sanjeev Bhatia ◽  
Brett R. Levine
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Cost Savings ◽  
Total Knee
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