Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Abstract Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Med...

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Bibliographic Details
Published in:The Journal of arthroplasty 2016-02, Vol.31 (2), p.362-367
Main Authors: Chin, Garwin, BSc, Wright, David J., MSc, Snir, Nimrod, MD, Schwarzkopf, Ran, MD, MSc
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - economics
conversion total hip arthroplasty
cost
Costs and Cost Analysis
Female
Hip Fractures - economics
Hip Fractures - surgery
Hospital Costs
Humans
implant cost
Male
Medicare - economics
Middle Aged
Orthopedics
primary total hip arthroplasty
revision total hip arthroplasty
Time Factors
United States
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Summary:Abstract Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients ( Current Procedure Terminology code 27132) and 105 matched primary THA patients ( Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different ( P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2015.08.014