Abstract
During a one-year period starting in October 2001, we analysed the intra-hospital cost of 102 primary elective total hip arthroplasty (THA) in a Belgian university hospital. Patients were treated according to age and general condition with an all cemented metal-poly THA (37), a uncemented cup and cemented metal-poly THA (40), an all uncemented ceramic-ceramic THA (18) or non-standard implants or combinations (7). On average patients stayed 14.4 days in the orthopaedic ward and intra-hospital cost was 9496 Euro (SD: 2178): 53.8% was related to hospitalisation, 21.3% to implants and material, 7.7% to surgery and 4.1% to anaesthesia. A multiple regression analysis was performed to identify possible influencing factors for intra-hospital cost and stay (pre-operative hip function, general health and dwelling as well as implant choice and intra-hospital complications). Overall, only the occurrence of complications during hospitalisation had a significant regression coefficient. In total 14 patients (13.7%) suffered at least one complication during hospitalization (dislocation: 4.9%, heamatoma or superficial infection: 2%, trochanter fracture: 1%, thrombosis with pulmonary embolism: 1%, general complications: 6.9%). This resulted in a significant higher cost (11823 versus 9125 Euro) and hospital stay (19.4 versus 13.6 days). For those patients who did not suffer complications, only implant choice and the place patients were discharged to had significant regression coefficients. The average implant cost for cemented metal-poly THA was 1444 Euro (16.1% of the total cost) compared to 2686 Euro (25.6% of the total cost) for uncemented ceramic-ceramic implants. Due to a chronic shortage of rehabilitation units in the Brussels region, discharged to these units led to both higher cost (10422 versus 9056 Euro) and longer hospital stay (16.5 versus 13.4 days). In the Belgian health insurance system, limitation of intra-hospital cost can best be achieved by shortening hospital stay after THA. This might include improved control of postoperative complications, faster rehabilitation programs and improved surgical techniques to reduce the needs for rehabilitation units and to allow earlier return to independency. Another option is to increase cost awareness regarding prolonged hospital stay of both, patients and medical staff.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
