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The hospital cost of hip replacement for old inpatients in Belgium

European Geriatric Medicine volume 10, pages 67–78 (2019)Cite this article

Abstract

Introduction

The objectives of this research are (i) to describe the medico-administrative characteristics of inpatients aged 65 and more who are hospitalized for hip joint replacement, (ii) to evaluate the complete hospital cost into costs of medical procedures, drugs costs, prostheses costs, and the administrative costs, and (iii) to identify and to evaluate from administrative database predictors influencing the complete hospital costs.

Methods

The study was based on 961 inpatient stays aged 65 and more, with the APR-DRG 301 “Hip joint replacement”. The sample for this study was based on data collected in 2014 among nine Belgian general hospitals. We used the linear regression method for isolating predictors of hospital cost.

Results

The study highlights three different types of patients hospitalized for hip replacement, depending on the primary diagnosis: osteoarthritis problems (57%), femur neck fracture (30%), or other reasons (13%) (complications, infections, or problems with the existing hip prosthesis). The median length of stay (P25–P75) was 9 days (6.29–20.91). The median cost (P25–P75) was 8,023.91 EUR (6678.32–13,670.78). The total cost was composed of the direct hospital cost (30%), the cost of medical procedures (31%), cost of drugs (4%), the cost of hip prosthesis (18%), and other costs (17%). The linear regression reveals that an extreme SOI or risk of mortality, an ICU stay, an in-hospital death, an index of Charlson comorbidities of 4 or 5, to be hospitalized for a hip replacement because of complications, infections, or problems with the existing hip prosthesis, and the length of stay, were predictors of an increase in hospital cost.

Conclusion

The cost is not increasing with the age of the patient, but mainly with the length of stay and the comorbidities linked to the age which are considered in the severity of illness and the Charlson comorbidities index. The hospital cost is higher for patients hospitalized for complications linked to an existing hip prosthesis than for a hip replacement linked to osteoarthritis problems.

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Author information

Affiliations

  1. ICHEC Brussels Management School, Brussels, Belgium

    Julie De Foor

  2. Centre de recherche en Economie de la Santé (Health Economics Research Center), Gestion des Institutions de Soins et Sciences Infirmières (Management of Institutions of care and nursing research), Ecole de Santé Publique (School of Public Health), Université Libre de Bruxelles, Brussels, Belgium

    Julie De Foor, Philippe Van Wilder, Pol Leclercq, Dimitri Martins & Magali Pirson

Authors
  1. Julie De Foor
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  2. Philippe Van Wilder
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  3. Pol Leclercq
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  5. Magali Pirson
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Correspondence to Julie De Foor.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval and informed consent

The patient records used in this retrospective study were fully anonymized by the hospitals before we accessed them. The research team does not have any access to the name, the ID number, or personal medical files of inpatients. For this retrospective study, ethical approval and informed consent is not required.

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De Foor, J., Van Wilder, P., Leclercq, P. et al. The hospital cost of hip replacement for old inpatients in Belgium. Eur Geriatr Med 10, 67–78 (2019). https://doi.org/10.1007/s41999-018-0150-3

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  • DOI: https://doi.org/10.1007/s41999-018-0150-3

Keywords

  • Hospital cost
  • Hip fracture
  • Hip osteoarthritis
  • Hip replacement
  • Older patient