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Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013.

Abstract Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay.
PMID
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Authors

Mayor MeshTerms

Hospital Costs

Keywords
Journal Title the journal of bone and joint surgery. american volume
Publication Year Start




PMID- 28244911
OWN - NLM
STAT- MEDLINE
DA  - 20170228
DCOM- 20170308
LR  - 20170323
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 99
IP  - 5
DP  - 2017 Mar 01
TI  - Effects of the Length of Stay on the Cost of Total Knee and Total Hip
      Arthroplasty from 2002 to 2013.
PG  - 402-407
LID - 10.2106/JBJS.16.00019 [doi]
AB  - BACKGROUND: Utilization of total knee and hip arthroplasty has greatly increased 
      in the past decade in the United States; these are among the most expensive
      procedures in patients with Medicare. Advances in surgical techniques,
      anesthesia, and care pathways decrease hospital length of stay. We examined how
      trends in hospital cost were altered by decreases in length of stay. METHODS:
      Procedure, demographic, and economic data were collected on 6.4 million
      admissions for total knee arthroplasty and 2.8 million admissions for total hip
      arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, 
      a component of the Healthcare Cost and Utilization Project. Trends in mean
      hospital costs and their association with length of stay were estimated using
      inflation-adjusted, survey-weighted generalized linear regression models,
      controlling for patient demographic characteristics and comorbidity. RESULTS:
      From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 
      days for total knee arthroplasty and from 4.06 to 2.75 days for total hip
      arthroplasty. During the same time period, the mean hospital cost for total knee 
      arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to
      $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall
      increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty
      increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI,
      $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay
      were set at the 2002 mean, the growth in cost for total knee arthroplasty would
      have been 70.8% instead of 52.4% as observed, and the growth in cost for total
      hip arthroplasty would have been 67.4% instead of 49.8% as observed. CONCLUSIONS:
      Hospital costs for joint replacement increased from 2002 to 2013, but were
      attenuated by reducing inpatient length of stay. With demographic characteristics
      showing an upward trend in the utilization of joint arthroplasty, including a
      shift toward younger population groups, reduction in length of stay remains an
      important target for procedure-level cost containment under emerging payment
      models.
FAU - Molloy, Ilda B
AU  - Molloy IB
AD  - 1Department of Orthopaedics, Dartmouth Hitchcock Medical Center (I.B.M., W.E.M., 
      and D.S.J.), and the Dartmouth Institute for Health Policy and Clinical Practice,
      Geisel School of Medicine at Dartmouth (B.I.M.), Lebanon, New Hampshire.
FAU - Martin, Brook I
AU  - Martin BI
FAU - Moschetti, Wayne E
AU  - Moschetti WE
FAU - Jevsevar, David S
AU  - Jevsevar DS
LA  - eng
GR  - K12 HS021695/HS/AHRQ HHS/United States
GR  - P60 AR062799/AR/NIAMS NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Arthroplasty, Replacement, Hip/*economics/statistics & numerical data
MH  - Arthroplasty, Replacement, Knee/*economics/statistics & numerical data
MH  - Female
MH  - *Hospital Costs/statistics & numerical data/trends
MH  - Hospitalization/economics/statistics & numerical data
MH  - Humans
MH  - Length of Stay/*economics/statistics & numerical data
MH  - Male
MH  - Medicare/*economics/statistics & numerical data
MH  - Middle Aged
MH  - Osteoarthritis/economics/epidemiology/*surgery
MH  - United States/epidemiology
MH  - Young Adult
PMC - PMC5324037
EDAT- 2017/03/01 06:00
MHDA- 2017/03/09 06:00
CRDT- 2017/03/01 06:00
PMCR- 2018/03/01
AID - 10.2106/JBJS.16.00019 [doi]
AID - 00004623-201703010-00006 [pii]
PST - ppublish
SO  - J Bone Joint Surg Am. 2017 Mar 1;99(5):402-407. doi: 10.2106/JBJS.16.00019.

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