Abstract
Background:
Complications following hip and knee arthroplasty can occur in any given patient. However, specific risk factors such as increased age, history of coexistent disease, and increased body mass index have been found to increase the risk of complications after such procedures. Complications often require prolonged hospital admission periods and added hospital resources which ultimately results in increased costs per hospital stay. However, if patients are pre-operatively risk stratified, and followed post-operatively for specific high risk medical issues, many complications may be avoided. By using a hospital standardised peri-operative risk stratification process, the cost per hospital stay for hip and knee arthroplasty may decrease.
Hypothesis:
Overall hospital costs related to joint arthroplasty will be decreased by using a multi-disciplinary peri-operative risk stratification programme.
Methods/Materials:
We reviewed 2,640 joint arthroplasty cases performed at one hospital from January 2008 until August 2012 consisting of primary and revision hip and knee arthroplasties. This group was separated into a non-triage group (N) and a triage group (T). The non-triage group (N) consisted of 1,142 cases that were performed prior to the formation of a multi-disciplinary peri-operative risk stratification programme for joint arthroplasty at the hospital. The triage group (T) consisted of 1,498 cases that were performed after the formation of a multi-disciplinary peri-operative risk stratification programme. These two groups were first compared with regards to ASA score and Charleston co-morbidity scale pre-operatively. Post-operatively the two groups were compared with regards to length of stay, major and minor complication rates up to 30 and 90 days, and cost per hospital stay.
Results:
The preliminary results have shown a statistically significant difference in length of stay between the two groups (p < 0.001) with the triage group (T) experiencing, on average, a half of a day decrease in length of stay when compared to the non-triage group (N). We found no statistically significant difference in complication rates between the two groups at either 30 or 90 days post-operatively; (p = 0.421) and (p = 0.669) respectively. Approximately $823,900 was saved over the study period. We also discovered a statistically significant difference in the baseline ASA score between the two groups (p < 0.01) showing that, on average, the triage group (T) had a higher ASA score than the non-triage group (N).
Conclusion:
After the establishment of a multi-disciplinary, peri-operative, risk stratification programme at our hospital, the average length of stay per knee and hip arthroplasty was significantly decreased per patient. The average complications rate per patient did not change significantly. These findings took place even though the ASA score of the population undergoing knee and hip arthroplasty increased significantly after the multi-disciplinary, peri-operative, risk stratification programme was established.
Level of evidence: Level III Retrospective Cohort
