Lower in-hospital costs associated with anterior approach for THA

Reduced length of hospital stay correlated with lower in-hospital costs.

Issue: May 2016

Results of this cost analysis of three approaches to total hip arthroplasty indicated a significant reduction of in-hospital costs associated with the anterior approach.

“The savings were realized through a reduction in the length of stay [LOS],” Edward M. Vasarhelyi, MD, MSc, FRCSC, assistant professor in the Division of Orthopaedic Surgery at Western University, London, Ontario, Canada, told Orthopedics Today. “When applying this to other institutions, it is important to operationalize procedure and hospital stay costs as two separate entities, both with respect to direct and indirect costs. By doing so, a reduction in costs can be achieved through work-flow efficiencies irrespective of the surgical approach used.”

Cost comparison

Vasarhelyi and his colleagues conducted a prospective micro-cost analysis for 118 patients who underwent total hip arthroplasty (THA) using an anterior, lateral or posterior approach. Total patient hospital LOS and any complications occurring within 3 months postoperatively, either in-hospital or after discharge, were recorded.

Preoperative time spent in day surgery and time spent in postanesthetic care unit (PACU) were used to determine the total in-hospital costs. The three surgical approaches were compared with one-way analysis of variance for OR time and costs, in-hospital costs, hospital LOS and total costs.

Higher costs, shorter LOS with DA

“The value in this data is not that the [direct anterior] DA is less expensive to perform from an institutional micro-costing perspective, but understanding when examining patient flow through acute care, each step (intraoperative, PACU, inpatient floor stay) should be scrutinized to ensure efficiencies are maximized to reduce both the direct and indirect costs,” Vasarhelyi said.

Findings showed OR time and costs were significantly less for the lateral approach compared with the anterior and posterior approaches. Mean hospital LOS was 33.9 hours for the anterior approach group compared with 65.8 hours and 64.2 hours, respectively, for the posterior and lateral approach groups. The overall surgical approach and total costs for the anterior, posterior and lateral approaches were $7,300.22, $8,287.46 and $7,853.10, respectively.

Limitations, future research

Vasarhelyi said there may be a limit to the generalizability of the cost data for other health care models due to the study being conducted in a single academic publicly funded health care system.

“The three treatment groups were expertise-based, with a different single surgeon performing the procedures in each of the groups. This has the potential for performance bias,” he said.

He added there may also be expectation bias among the physiotherapists not blinded to the surgical approach type. Weight-bearing status and milestones for discharge being standardized according to the institution’s discharge pathway may also have influenced the investigators’ LOS expectation bias.

“We are in the process of obtaining the outpatient cost data associated with the three surgical approaches with long term effectiveness measures (i.e. quality-adjusted life years) in order to perform a cost effectiveness analysis from a societal perspective,” Vasarhelyi said.” by Monica Jaramillo

Reference:
Petis SM, et al. J Arthroplasty. 2015; doi:10.1016/j.arth.2015.08.034.

For more information:
Edward M. Vasarhelyi, MD, MSc, FRCSC, can be reached at the Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, 339 Windermere Rd, PO Box 5339, London, ON, Canada N6A 5A5; email: Edward.Vasarhelyi@lhsc.on.ca.

Disclosures: Vasarhelyi reports he is a consultant for Depuy. The study was funded by Physicians Services Incorporated and Western University Lawson Internal Research Fund. The study also received institutional support from DePuy, Smith and Nephew and Stryker.