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Unplanned Hip Arthroplasty Imposes Clinical and Cost Burdens on Treating Institutions

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Emergent surgery has been shown to be a risk factor for perioperative complications. Studies suggest that patient morbidity is greater with an unplanned hip arthroplasty, although it is controversial whether unplanned procedures also result in higher patient mortality. The financial impact of these procedures is not fully understood, as the costs of unplanned primary hip arthroplasties have not been studied previously.

Questions/purposes

We asked: (1) What are the institutional costs associated with unplanned hip arthroplasties (primary THA, hemiarthroplasty, revision arthroplasty, including treatment of periprosthetic fractures, dislocations, and infections)? (2) Does timing of surgery (urgent/unplanned versus elective) influence perioperative outcomes such as mortality, length of stay, or need for advanced care? (3) What diagnoses are associated with unplanned surgery and are treated urgently most often? (4) Do demographics and insurance status differ between admission types (unplanned versus elective hip arthroplasty)?

Methods

We prospectively followed all 419 patients who were admitted to our Level I trauma center in 2011 for procedures including primary THA, hemiarthroplasty, and revision arthroplasty, including the treatment of periprosthetic fractures, dislocations, and infections. Fifty-seven patients who were treated urgently on an unplanned basis were compared with 362 patients who were treated electively. Demographics, admission diagnoses, complications, and costs were recorded and analyzed statistically.

Results

Median total costs were 24% greater for patients admitted for unplanned hip arthroplasties (USD18,206 [USD15,261–27,491] versus USD14,644 [USD13,511–16,309]; p < 0.0001) for patients admitted for elective arthroplasties. Patients with unplanned admissions had a 67% longer median hospital stay (5 days [range, 4–9 days] versus 3 days [range, 3–4 days]; p < 0.0001) for patients with elective admissions. Mortality rates were equivalent between groups (p = 1.0). Femoral fracture (p < 0.0001), periprosthetic fracture (p = 0.01), prosthetic infection (p = 0.005), and prosthetic dislocation (p < 0.0001) were observed at higher rates in the patients with unplanned admissions. These patients were older (p = 0.04), less likely to have commercial insurance (p < 0.0001), more likely to be transferred from another institution (p < 0.0001), and more likely to undergo a revision procedure (p < 0.0001).

Conclusions

Unplanned arthroplasty and urgent surgery are associated with increased financial and clinical burdens, which must be accounted for when considering bundled quality and reimbursement measures for these procedures.

Level of Evidence

Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, Cupp 1, 39th and Market Streets, Philadelphia, PA, 19104, USA

    Atul F. Kamath MD & Craig L. Israelite MD

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Daniel C. Austin BA

  3. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Peter B. Derman MD, MBA

Authors
  1. Atul F. Kamath MD
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  2. Daniel C. Austin BA
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  3. Peter B. Derman MD, MBA
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  4. Craig L. Israelite MD
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Corresponding author

Correspondence to Atul F. Kamath MD.

Additional information

One of the authors certifies that he (CLI) has or may receive payments or benefits, during the study period, an amount of less than USD 10,000, from Zimmer, Inc (Warsaw, IN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Pennsylvania, Philadelphia, PA, USA.

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Kamath, A.F., Austin, D.C., Derman, P.B. et al. Unplanned Hip Arthroplasty Imposes Clinical and Cost Burdens on Treating Institutions. Clin Orthop Relat Res 471, 4012–4019 (2013). https://doi.org/10.1007/s11999-013-3226-x

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  • DOI: https://doi.org/10.1007/s11999-013-3226-x

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