Revenue did not increase with cost of TKA in patients with high comorbidity burden
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Key takeaways:
- Patients with a high comorbidity burden had more readmissions and longer stays after total knee arthroplasty.
- Revision and complication rates were equal to those of patients without high comorbidity burdens.
SAN FRANCISCO — Results showed costs for total knee arthroplasty increased for patients with a high comorbidity burden, but revenue remained the same as patients without a high comorbidity burden, leading to a decreased contribution margin.
Ran Schwarzkopf, MD, and colleagues stratified 10,647 patients who underwent elective, unilateral TKA between 2012 and 2021 into groups based on whether they had a high comorbidity burden.
“We decided to look at the high-risk patients and we looked at patients not surgically complicated, but medically complicated,” Schwarzkopf, professor in the department of orthopedic surgery at the NYU Grossman School of Medicine and site chief at NYU Langone Orthopedic Hospital, told Healio about research that received the Best Paper Award at the American Academy of Orthopaedic Surgeons Annual Meeting. “We described them based on comorbidity scales, [American Society of Anesthesiologists] ASA scale, and we defined them as high-risk patients with high comorbidity burdens.”
Researchers compared perioperative data, revenue, costs and contribution margins of the inpatient episode, as well as 90-day readmission and revision rates between the two groups.
Schwarzkopf said patients in the high comorbidity burden group had higher readmission rates and a longer hospital stay. He added that discharge destinations were different between patients with and those without a high comorbidity burden. While these outcomes increased direct costs for patients with a high comorbidity burden, researchers found hospital revenue did not differ between the two groups, leading to a decreased contribution margin for the high comorbidity burden group by almost 20%.
“On the other hand, we saw that the overall revision rates and surgical complications were equal,” Schwarzkopf said. “They do not have any increased revisions in the first 90 days. They do not have any increased surgical complications. The surgical time in the OR is the same.”
As more surgeons move their practices to the ASC setting, Schwarzkopf said patients with high comorbidity burdens but low-risk profiles may have problems with access to care as treatment will be cost-prohibitive for institutions.
“It will be important for hospitals to try to get [diagnosis-related group] DRG 469 vs. 470 for these high comorbidity patients,” Schwarzkopf said. “We need to advocate and we need to push for this, but we have to continue caring for these patients because, surgically, they do well.”
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Thomas J, et al. Paper 64. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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