Sue L. Visscher

Determinants of Direct Medical Costs in Primary and Revision Total Knee Arthroplasty

BackgroundTKA procedures are increasing rapidly, with substantial cost implications. Determining cost drivers in TKA is essential for care improvement and informing future payment models.Questions/PurposesWe determined the components of hospitalization and 90-day costs in primary and revision TKA and the role of demographics, operative indications, comorbidities, and complications as potential determinants of costs.MethodsWe studied 6475 primary and 1654 revision TKA procedures performed between January 1, 2000, and September 31, 2008, at a single center. Direct medical costs were measured by using standardized, inflation-adjusted costs for services and procedures billed during the 90-day period. We used linear regression models to determine the cost impact associated with individual patient characteristics.ResultsThe largest proportion of costs in both primary and revision TKA, respectively, were for room and board (28% and 23%), operating room (22% and 17%), and prostheses (13% and 24%). Prosthesis costs were almost threefold higher in revision TKA than in primary TKA. Revision TKA procedures for infections and bone and/or prosthesis fractures were approximately 25% more costly than revisions for instability and loosening. Several common comorbidities were associated with higher costs. Patients with vascular and infectious complications had longer hospital stays and at least 80% higher 90-day costs as compared to patients without complications.ConclusionsHigh prosthesis costs in revision TKA represent a factor potentially amenable to cost containment efforts. Increased costs associated with demographic factors and comorbidities may put providers at financial risk and may jeopardize healthcare access for those patients in greatest need.Level of EvidenceLevel IV, economic and decision analyses. See Instructions for Authors for a complete description of levels of evidence

The effect of obesity on direct medical costs in total knee arthroplasty.

BACKGROUND Obesity prevalence continues to rise in the United States. We sought to examine the effect of obesity on length of hospital stay and direct medical costs in a large cohort of patients who underwent total knee arthroplasty. METHODS The study included 8129 patients who had undergone 6475 primary total knee arthroplasties and 1654 revision total knee arthroplasties at a large U.S. medical center from January 1, 2000, to September 30, 2008. Patients with bilateral procedures within ninety days following the index admission were excluded. Data on clinical and surgical characteristics and complications were obtained from the original medical records and the institutional joint registry. Patients were classified into eight groups based on their body mass index at the time of surgery. Direct medical costs were calculated in 2010 U.S. dollars by using standardized, inflation-adjusted costs for services and procedures billed during hospitalization and the ninety-day window. Study end points were hospital length of stay and direct medical costs. End points were compared across the eight body mass index categories in both unadjusted and multivariable risk-adjusted analyses. Linear regression models were used to determine the cost impact associated with increasing body mass index and obesity accounting for comorbidities and complications. RESULTS Body mass index data were available for 99.5% of patients and ranged from 15 to 73 kg/m2. Length of stay and the direct medical costs were lowest for patients with body mass index values in the normal to overweight range. Increasing body mass index was associated with significantly longer hospital stays and costs. Every 5-unit increase in body mass index beyond 30 kg/m2 was associated with approximately

Improving Affordability Through Innovation in the Surgical Treatment of Mitral Valve Disease

250 to

Dividend yield strategies in the British stock market

300 higher hospitalization costs in primary total knee arthroplasty and

Developing a standardized healthcare cost data warehouse

600 to

Direct medical costs of accidental falls for adults with transfemoral amputations

650 higher hospitalization costs in revision total knee arthroplasty. These estimates persisted after adjusting for comorbidities or complications. CONCLUSIONS Obesity is associated with longer hospital stays and higher costs in total knee arthroplasty. The effect of obesity on costs appears to be independent of obesity-related comorbid conditions and complications.

Incorporating the Last Four Digits of Social Security Numbers Substantially Improves Linking Patient Data from De‐identified Hospital Claims Databases

OBJECTIVE To determine whether technically innovative cardiac surgical platforms (ie, robotics) deployed in conjunction with surgical process improvement (systems innovation) influence total hospital costs to address the concern that expanding adoption might increase health care expenses. PATIENTS AND METHODS We studied 185 propensity-matched patient pairs (370 patients) undergoing isolated conventional open vs robotic mitral valve repair with identical repair techniques and care teams between July 1, 2007, and January 31, 2011. Two time periods were considered, before the implementation of system innovations (pre-July 2009) and after implementation. Generalized linear mixed models were used to estimate the effect of the type of surgery on cost while adjusting for a time effect. RESULTS Baseline characteristics of the study patients were similar, and all patients underwent successful mitral valve repair with no early deaths. Median length of stay (LOS) for patients undergoing open repair was unchanged at 5.3 days (P=.636) before and after systems innovation implementation, and was lower for robotic patients at 3.5 and 3.4 days, respectively (P=.003), throughout the study. The overall median costs associated with open and robotic repair were

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

31,838 and

Predictors of Receiving a Prosthesis for Adults With Above-Knee Amputations in a Well-Defined Population

32,144, respectively (P=.32). During the preimplementation period, the total cost was higher for robotic (

The risk of major cardiovascular events for adults with transfemoral amputation

34,920) than for open (