Cost analysis of revision total hip arthroplasty - A 5-year followup study

A stratified, unselected sample of 30 patients who underwent revision total hip arthroplasty between 1990 and 1992 for whom complete clinical and fina ncial data were available was studied. Clinical data included age, gender, diagnosis, length of stay, operative time and blood loss. Financial data in cluded cost of implants, bone graft and accessories, hospital charge, and s urgeon reimbursement. Results were compared with the results of an analogou s group of 50 patients who underwent revision total hip arthroplasty at the same institution between 1995 and 1997. Cases were classified as simple (i nvolving revision of only, acetabular liner and/or femoral head), routine:( revision of acetabular and/or femoral components), or complex (major struct ural graft, antiprotrusio cage, impacted grafting). For patients undergoing routine revision total hip arthroplasty, a dramatic decline of 52% occurre d in length of stay during the 5-year span (10.7 days to 5.1 days). The ave rage operative time also declined significantly (238 minutes to 199 minutes ) as did the average implant cost ($4349 to $2827). Despite this, the avera ge hospital charge increased 16% ($29,666 to $34,328). There was a signific ant and dramatic 35% decline in surgeon reimbursement ($3240 to $2178). The re was no significant difference in surgeon reimbursement between simple, r outine, and complex total hip arthroplasty. Patients who underwent complex procedures had a significantly greater length of stay (7.3 versus 5.1 days) and operative time (297 versus 199 minutes). The hospital charge was drama tically higher for patients undergoing complex procedures ($51,290 versus $ 34,328) but the surgeon reimbursement was lower on average, although not st atistically significant ($1926 versus $2178). There was a significant incre ase in the number and complexity of revision total hip arthroplasties betwe en the two periods. Significant decreases were achieved in length of stay, operating room time, and implant cost. Benefits from these changes were acc rued to the hospital but not the surgeon because hospital costs decreased s ignificantly whereas surgeon reimbursements declined dramatically.