scholarly journals Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty：a university affiliated hospital survey of 1579 Chinese patients

2019 ◽  
Author(s):  
Ji-Fei Hou ◽  
Chuan Hu ◽  
Yan-Zheng Liu ◽  
Chi Zhang ◽  
Jing Li ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Statistical Significance ◽  
Cost Effective ◽  
Medical Costs ◽  
Chinese Patients ◽  
Single Institution ◽  
Total Arthroplasty ◽  
Total Knee ◽  
Simultaneous Bilateral Tka ◽  
Total Average

Abstract Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are required for many patients. No recent studies that concentrate on the costs for each of the payment items both for TKA and THA when comparing simultaneous bilateral procedures with staged arthroplasty. This study aimed to evaluate the medical costs, length of stay(LOS), blood transfusion, and in-hospital complications in patients undergoing simultaneous TKA or THA and staged TKA or THA. Methods A retrospective cohort study was conducted by analyzing 1,579 patients from a single institution. All patients who underwent primary bilateral TKA or THA from 2013 to 2018 were divided into simultaneous bilateral and staged bilateral groups. These two sub-groups were compared between three groups(TKA, THA, and pooled groups). Results All categories of medical costs, except for materials fees which were higher in the simultaneous bilateral THA and pooled groups but with no statistical significance, were lower in the simultaneous TKA, THA and pooled simultaneous groups. The total average medical costs in simultaneous and staged bilateral TKA groups were $15,535.621($12,362.542,$16,450.131)and $16,747.192($14,670.273, $18,036.289), (p <0.001), respectively; THA groups were $15,046.210 ($12,838.230, $17,026.529) and $16,126.808 ($14,575.031, $18,867.963), (p=0.003), respectively; pooled groups were $16,506.971 ($14,618.267, $18,185.414) and $15,467.561 ($12,432.783, $16,494.155), (p <0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for complications between the two sub-groups in three groups. The simultaneous groups had a shorter LOS, a higher incidence of blood transfusion than staged groups whether it is TKA groups or THA or pooled groups. Conclusions These results indicate that simultaneous bilateral TKA and THA with a shorter LOS is more cost-effective than staged bilateral TKA and THA. Counts of complications were not affected by the choice for staged or simultaneous bilateral total arthroplasty. But blood transfusion was more prevalent in the simultaneous groups both for TKA and THA.

scholarly journals Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

2020 ◽  
Author(s):  
Ji-Fei Hou ◽  
Chuan hu ◽  
Yun Zhang ◽  
Yan-Zheng Liu ◽  
Chi Zhang ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hip Arthroplasty ◽  
Statistical Significance ◽  
Medical Costs ◽  
The United States ◽  
Chinese Patients ◽  
United States Dollar ◽  
Total Arthroplasty ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

Abstract Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are required for many patients. No recent studies that concentrate on the costs for each of the payment items both for TKA and THA when comparing simultaneous bilateral procedures with staged arthroplasty. This study aimed to evaluate the medical costs, length of stay(LOS), blood transfusion, and in-hospital complications in patients undergoing simultaneous TKA or THA and staged TKA or THA. Methods A retrospective cohort study was conducted by analyzing 1,579 patients from a single institution. All patients who underwent primary bilateral TKA or THA from 2013 to 2018 were divided into three groups: TKA,THA and all patients. Then, we grouping simultaneous bilateral groups and staged bilateral groups in these three groups respectively. Finally, these two sub-groups(simultaneous bilateral groups and staged bilateral groups) were compared between the three groups(TKA, THA, and pooled groups). Results All categories of medical costs, except for materials fees which were higher in the simultaneous bilateral THA and pooled groups but with no statistical significance, were lower in the simultaneous TKA, THA and pooled simultaneous groups. The total average medical costs in simultaneous and staged bilateral TKA groups were $15,535.621and $16,747.192, p <0.001), respectively; THA groups were $15,046.210 and $16,126.808, ( p =0.003), respectively; pooled groups were $16,506.971and $15,467.561, ( p <0.001), respectively. All costs were presented in the United States dollar. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common co-morbidities and postoperative complications between the two sub-groups in three groups. The simultaneous groups had a shorter LOS, a higher incidence of blood transfusion than staged groups whether it is TKA groups or THA or pooled groups. Conclusions These results indicate that simultaneous bilateral TKA and THA with a shorter LOS is more economical than staged bilateral TKA and THA. Counts of complications were not affected by the choice for staged or simultaneous bilateral total arthroplasty. But blood transfusion was more prevalent in the simultaneous groups both for TKA and THA.

scholarly journals Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

2020 ◽  
Author(s):  
Ji-Fei Hou ◽  
Chuan Hu ◽  
Yun Zhang ◽  
Yan-Zheng Liu ◽  
Chi Zhang ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hip Arthroplasty ◽  
Statistical Significance ◽  
Medical Costs ◽  
The United States ◽  
Chinese Patients ◽  
United States Dollar ◽  
Total Arthroplasty ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

Abstract Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are required for many patients. No recent studies that concentrate on the costs for each of the payment items both for TKA and THA when comparing simultaneous bilateral procedures with staged arthroplasty. This study aimed to evaluate the medical costs, length of stay(LOS), blood transfusion, and in-hospital complications in patients undergoing simultaneous TKA or THA and staged TKA or THA. Methods: A retrospective cohort study was conducted by analyzing 1,579 patients from a single institution. All patients who underwent primary bilateral TKA or THA from 2013 to 2018 were divided into three groups: TKA,THA and all patients. Then, we grouping simultaneous bilateral groups and staged bilateral groups in these three groups respectively. Finally, these two sub-groups(simultaneous bilateral groups and staged bilateral groups) were compared between the three groups(TKA, THA, and pooled groups). Results: All categories of medical costs, except for materials fees which were higher in the simultaneous bilateral THA and pooled groups but with no statistical significance, were lower in the simultaneous TKA, THA and pooled simultaneous groups. The total average medical costs in simultaneous and staged bilateral TKA groups were $15,535.621and $16,747.192, p <0.001), respectively; THA groups were $15,046.210 and $16,126.808, ( p =0.003), respectively; pooled groups were $16,506.971and $15,467.561, ( p <0.001), respectively. All costs were presented in the United States dollar. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common co- morbidities and postoperative complications between the two sub-groups in three groups. The simultaneous groups had a shorter LOS, a higher incidence of blood transfusion than staged groups whether it is TKA groups or THA or pooled groups. Conclusions: These results indicate that simultaneous bilateral TKA and THA with a shorter LOS is more economical than staged bilateral TKA and THA. Counts of complications were not affected by the choice for staged or simultaneous bilateral total arthroplasty. But blood transfusion was more prevalent in the simultaneous groups both for TKA and THA.

scholarly journals Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041147
Author(s):  
Ji-Fei Hou ◽  
Chuan Hu ◽  
Yun Zhang ◽  
Li-Qi Tian ◽  
Yan-Zheng Liu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Nursing Care ◽  
Hip Arthroplasty ◽  
Medical Costs ◽  
Complication Rates ◽  
Propensity Score Matching Analysis ◽  
Total Knee ◽  
The Difference

BackgroundTotal joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA.MethodsAll patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups.ResultsExcept for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively.ConclusionsOur results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.

Peri-articular infiltration in the resource-restrained environment - still a worthwhile adjunct to multimodal analgesia post total knee replacement

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
M Van Heukelum ◽  
CA Blake ◽  
T Franken ◽  
MC Burger ◽  
N Ferreira ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Intervention Group ◽  
Cost Effective ◽  
Multimodal Analgesia ◽  
Randomised Control Trial ◽  
Saline Control ◽  
Control Group ◽  
Resource Poor ◽  
Vas Scores ◽  
Total Knee

ABSTRACT BACKGROUND: Peri-articular infiltrations (PAI) in total knee arthroplasty (TKA) offer effective analgesia, and are cost effective, safe and easy to perform. Currently there is no gold standard technique based on evidence-based medicine; described methods are based on consensus recommendations. The latest literature supports PAI including complex and multiple drug combinations, such as liposomal bupivacaine, ropivacaine and ketorolac, which are not available in all settings. This study aims to prove that a basic PAI technique using widely available and inexpensive agents offers good and effective outcomes in a resource-poor environment METHODS: A double-blind randomised control trial compared the effectiveness of PAI with a simple, widely available anaesthetic solution (bupivacaine and adrenalin) to a normal saline control group. Infiltration volumes were calculated at 1 ml/kg and the infiltration technique followed a specific protocol. Post-operative outcomes included visual analogue scores (VAS), ambulation scores, morphine use, knee range of motion (ROM) and time to discharge RESULTS: Two comparable groups of 26 patients each were included (intervention: 81% female, mean age 64.8±8.8 years vs control: 65% female, mean age 67.0±7.6 years). All pain-related measures favoured the intervention group but failed to reach statistical significance at 24 and 72 hours. Mean VAS scores at 48 hours were significantly lower in the intervention group. (VAS score 3.0±1.6 vs 4.1±1.2, p=0.013). The other parameters measured strongly favoured the intervention group but did not prove to be significant CONCLUSIONS: A volume per kilogram PAI technique making use of widely available, cost-effective agents provides a statistical reduction in VAS scores at 48 hours post TKA. This suggests that in a resource-poor environment PAI is still a valuable addition to the multimodal analgesia pathway in the post-operative management of TKA. Maximum drug doses may show even more promising results, specifically in the first 24 hours post-operatively. Further studies investigating PAI for TKA in resource-restrained environments are indicated Level of evidence: Level 2 Keywords: standardisation peri-articular infiltration, multimodal analgesia, pre-emptive analgesia

scholarly journals PSVII-3 Correlations between L-lactate concentrations obtained using a handheld lactate analyser and a lactate assay colorimetric kit in beef cattle transported by road

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 296-297
Author(s):  
Daniela M Meléndez ◽  
Sonia Marti ◽  
Luigi Faucitano ◽  
Derek B Haley ◽  
Timothy D Schwinghamer ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Cost Effective ◽  
Road Transportation ◽  
Long Distance ◽  
Suitable Alternative ◽  
Blood Samples ◽  
Handheld Device ◽  
Time Points ◽  
Relationship Of ◽  
The Relationship

Abstract Blood metabolites are used to assess a variety of animal conditions for veterinary diagnosis and research. Concentration of metabolites in blood can be measured using a commercially-available lab-based assay or in real-time using a handheld device developed to be more time- and cost-effective than the lab-based method. Lactate is a product of anaerobic glycolysis, used in animal research as an indicator of muscle fatigue. Therefore, it has been used as an indicator of cattle response to long distance transportation. The aim of this study was to assess the relationship of L-lactate concentrations measured using a Lactate Scout+ analyzer (Lactate Scout, EFK Diagnostics, Barleben, Germany) and a lactate assay colorimetric kit (Lactate Assay Kit, Cell Biolabs Inc., San Diego, CA). Blood samples were collected by venipuncture from 96 steers (245 ± 35.7 kg BW) prior to (L1) and after 36 h, and prior to and after an additional 4 h of road transportation, and on d 1, 2, 3, 5, 14, and 28 after transport. The Lactate Scout+ analyzer strip was dipped in blood at the time of sampling, while blood samples were collected into sodium fluoride tubes for use in colorimetric analysis. Pearson correlations were calculated to determine the relationship between the experimental methods for the quantification of L-lactate concentrations. The strengths and levels of statistical significance of the correlation varied over the observed time points, r = -0.03, P = 0.75 (L1) to r = 0.75, P = &lt; 0.0001 (d 3). The correlation for the pooled data was weak but statistically significant (r = 0.33, P &lt; 0.001). Based on the experimental results, the Lactate Scout+ analyzer is not a suitable alternative to a lab-based assay for measuring L-lactate in transported cattle, due to variability across sampling time points and weak correlation with the traditional enzymatic method.

scholarly journals Clinical Outcome of Autologous Serum Therapy in Chronic Idiopathic Urticaria

2017 ◽  
Vol 15 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Dharmendra Karn ◽  
Shekhar KC
Keyword(s):  
Skin Prick Test ◽  
Chronic Urticaria ◽  
Statistical Significance ◽  
Cost Effective ◽  
Chronic Idiopathic Urticaria ◽  
Autologous Serum ◽  
P Value ◽  
Prick Test ◽  
H1 Antihistamines ◽  
Serum Therapy

Background: Quality of life in chronic idiopathic urticaria is hampered as efficacy of H1-antihistamines is limited. Autologous serum containing tolerance-generating anti-idiotype antibodies is a novel and cost-effective therapy. This study was conducted to evaluate the efficacy of autologous serum therapy (AST) among chronic urticaria patients with autologous skin prick test positive and negative status.Methods: Untreated 102 patients of chronic urticaria were enrolled in a non-randomized interventional study. Patients were categorized into two groups based on autologous serum skin prick test as test positive (ASST +) and test negative (ASST -). Patients were then treated with intramuscular injection of 0.05ml per kg body weight of autologous serum weekly for 10 weeks. Urticaria activity scoring (UAS) tool was used for quantification of the symptoms. Weekly recording of UAS (range: 0-42) was made before the therapy (baseline) and during the therapy for 10 weeks.Results: Significant improvement with AST in the mean UAS was noted from baseline to 10 weeks in both the group of patients (14.6 ± 6.3 and 10.2 ± 5.1 for ASST+ group; 16.9 ± 7.8 and 8.6 ± 4.8 for ASST- group; at baseline and 10 weeks, respectively (p-value for both <0.05)). However no statistical significance was found while comparing the efficacy of the therapy against ASST + and ASST - Groups (p-value > 0.05).Conclusions: Irrespective of autologous skin prick test results, autologous serum therapy showed significant improvement in patients with chornic idiopathic urticaria. AST can, thus, be an effective treatment modality for it.

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