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Several risk factors associated with increased hospital charges for TJA
DALLAS — Anemia, malnutrition, obesity, diabetes, narcotic use and tobacco use were identified as modifiable risk factors associated with increased 90-day cost-of-care for patients after total joint arthroplasty, according to a speaker.
“Over the last 6 years, there have been nearly 1,000 articles published on these risk factors, but few are helpful when looking at population management because [these articles] look at a single risk factor,” William C. Schroer, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting. “There are few [articles] that look at relative risk between these risk factors and do not give us a guidance on how we should approach these.”
A total of 6,968 lower extremity joint replacement procedures performed across a five-hospital network between 2014 and 2015 were reviewed, and total 90-day cost-of-care was calculated. Researchers compared length of stay, emergency room visits and hospital readmission.
Results showed mean 90-day charges under the Comprehensive Care for Joint Replacement (CJR) model was $36,647. The increase in 90-day charges was $15,869 in 126 patients with anemia, $9,270 in 592 patients with malnutrition, $2,048 in 445 patients who were obese, $5,074 in 291 patients with diabetes, $1,801 in 1,943 patients who used narcotics and $2,034 in 1,882 patients who used tobacco. Furthermore, intensive-care unit admission rate, emergency room visits and hospital readmission were higher in all risk factors.
“Total charges was significantly higher in the fracture group. A larger concern is that the standard deviation is 2.5-times higher in the fracture group,” Schroer said. “CJR was developed to decrease variability in care, but [for] these fracture patients, the variability is not in the care, the variability is in the patients. This questions the appropriateness of these fractures being in the bundle.” – by Nhu Te
Reference:
Schroer W, et al. Paper #22. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 10-13, 2016; Dallas.
Disclosure: Schroer reports no relevant financial disclosures.