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Use of off-label devices increased costs and length of stay in TJA
Greater length of stay, admission costs, long-term complications risks and inpatient facility discharge likelihood was found among patients who underwent total hip or knee arthroplasty with an off-label prosthesis, according to results.
Researchers retrospectively queried the Nationwide Inpatient Sample from 2000 to 2010 and identified 2,566,523 primary total hip arthroplasty (THA) and 5,203,340 primary total knee arthroplasty (TKA) cases. The primary outcome measure “was annual trends in the national rate of off-label THA and TKA,” while secondary outcome measures included hospital length of stay, admission cost, perioperative complication rate and inpatient facility discharge rate by label status, according to the researchers.
Overall, 34.8% of cases were categorized as off-label with a prevalence of 30.4% in THA patients and 37% in TKA patients, according to results. Researchers noted that by 2040, at least 86.1% of THAs and 91.5% of TKAs could be off-label.
Results also showed off-label THA patients stayed an average of 0.3 days longer in the hospital with admissions costs averaging $1,139 higher compared with on-label patients. Similarly, off-label TKA patients stayed an average of 0.11 days longer in the hospital with admissions costs averaging $816 higher. Results also showed an increased likelihood of one or more defined perioperative complications associated with off-label patients. Among THA and TKA patients, the most expensive to treat (> $20,000) and at greatest risk for complications (27%-52% complication rate) included patients with vertical column fractures, severe alcohol dependence and hemiplegia, according to an analysis of individual off-label diagnoses. Off-label THA patients also experienced a slightly elevated inpatient mortality rate (0.3%) vs. on-label THA patients (0.2%), according to the researchers. However, off-label and on-label TKA patients experienced similar hospital mortality rates (0.1% for both). – by Casey Tingle
Disclosures: Malcolm reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.