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Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications.

Publication ,  Journal Article
Ryan, SP; DiLallo, M; Attarian, DE; Jiranek, WA; Seyler, TM
Published in: J Arthroplasty
August 2018

BACKGROUND: With the increasing incidence of hip fractures and hip preservation surgeries, there has been a concomitant rise in the number of conversion total hip arthroplasties (THAs) performed. Prior studies have shown higher complication rates in conversion THA. However, there is a paucity of data showing differences in cost between these 2 procedures. Currently, the Center for Medicare and Medicaid Services bundles primary and conversion THA in the same Medicare Severity-Diagnosis Related Group for hospital reimbursement. More evidence is needed to support the reclassification of conversion THA. METHODS: The cohort provided by the institutional database included 163 conversion THAs between January 1, 2012 and December 31, 2015. Intraoperative complications, estimated blood loss, operative time, postoperative complications, and perioperative cost data were analyzed for 163 primary THA patients matched to the conversion THA cohort. RESULTS: Compared with primary THA, conversion THA had significantly (P < .05) greater cost for direct labor, other direct costs, intermediate nursing services, other diagnostic/therapy, surgery services, physical/occupational/speech therapy, radiology, laboratories, blood, medical/surgical supply, and total direct costs. In addition, the conversion THA group had significantly greater operative times, estimated blood loss, length of stay, intraoperative complications, and postoperative complications. CONCLUSION: Conversion THA, as compared with primary THA, is associated with greater costs (approximately 19% greater), increased surgical times, and perioperative complications. To prevent these additional expenses from creating patient selection bias and a barrier to care, the conversion THA Medicare Severity-Diagnosis Related Group should be reclassified, or modifiers created.

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Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

August 2018

Volume

33

Issue

8

Start / End Page

2405 / 2411

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Postoperative Complications
  • Patient Acceptance of Health Care
  • Orthopedics
  • Operative Time
  • North Carolina
  • Middle Aged
  • Medicare
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ryan, S. P., DiLallo, M., Attarian, D. E., Jiranek, W. A., & Seyler, T. M. (2018). Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications. J Arthroplasty, 33(8), 2405–2411. https://doi.org/10.1016/j.arth.2018.03.006
Ryan, Sean P., Marcus DiLallo, David E. Attarian, William A. Jiranek, and Thorsten M. Seyler. “Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications.J Arthroplasty 33, no. 8 (August 2018): 2405–11. https://doi.org/10.1016/j.arth.2018.03.006.
Ryan SP, DiLallo M, Attarian DE, Jiranek WA, Seyler TM. Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications. J Arthroplasty. 2018 Aug;33(8):2405–11.
Ryan, Sean P., et al. “Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications.J Arthroplasty, vol. 33, no. 8, Aug. 2018, pp. 2405–11. Pubmed, doi:10.1016/j.arth.2018.03.006.
Ryan SP, DiLallo M, Attarian DE, Jiranek WA, Seyler TM. Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications. J Arthroplasty. 2018 Aug;33(8):2405–2411.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

August 2018

Volume

33

Issue

8

Start / End Page

2405 / 2411

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Postoperative Complications
  • Patient Acceptance of Health Care
  • Orthopedics
  • Operative Time
  • North Carolina
  • Middle Aged
  • Medicare
  • Male