Aims. The purpose of this study was to evaluate the cost of reverse shoulder arthroplasty (RSA) for patients with a proximal humerus fracture, using time-driven activity based costing (TDABC), and to compare treatment costs with reimbursement under the Healthcare Resource Groups (HRGs). Methods. TDABC analysis based on the principles outlined by Kaplan and a clinical pathway that has previously been validated for this institution was used. Staffing cost, consumables, implants, and overheads were updated to reflect 2019/2020 costs. This was compared with the HRG reimbursements. Results. The mean cost of a RSA is £7,007.46 (£6,130.67 to £8,824.67). Implants and staffing costs were the primary cost drivers, with implants (£2,824.80) making up 40% of the costs. Staffing costs made up £1,367.78 (19%) of overall costs. The total tariff, accounting for market force factors and high comorbidities, reimburses £4,629. If maximum cost and minimum reimbursement is applied the losses to the trust are £4,828.67. Conclusion. RSA may be an effective and appropriate surgical option in the treatment of proximal humerus fractures; however, a cost analysis at our centre has demonstrated the
Infective complications following implant related orthopaedic surgery or fracture related infection are associated with high costs and increased length of stay (LOS). However, the economic burden of disease before, during and after definitive osteomyelitis surgery is not well quantified. The Hospital Episode Statistics (HES) database captures all admissions, outpatient appointments and emergency department attendances at NHS hospitals in England. We identified all patients with a diagnostic code of osteomyelitis and quantified the tariff costs associated with the surgical treatment of osteomyelitis. We also collected all recorded healthcare events related to osteomyelitis for two years preceding the initial osteomyelitis treatment procedure, as well as for two years after the procedure. We compared average osteomyelitis treatment costs in England against a dedicated specialist multidisciplinary bone infection centre. We interrogated the HES database for all patients given a diagnostic code of osteomyelitis (M86) between April 2013 and January 2017. We excluded all cases with a diagnosis of osteomyelitis and an index procedure of an amputation for diabetes or arterial disease. Of the remaining 104,622 patients there were 24,408 cases who had their index procedure for osteomyelitis in this time period. Of these we compared a subset of 575 cases treated in a specialist bone infection centre.Aims
Methods
Theatre-listed trauma patients routinely require two ‘group and save’ blood-bank samples, in case they need perioperative transfusion. The Welsh Blood Service (WBS) need patients to have one recorded sample from any time in the last 10 years. A second sample, to permit cross-matching and blood issuing, must be within 7 days of transfusion (or within 48 hours if the patient is pregnant, or has been transfused within the last 3 months). The approximate cost of processing a sample is £15.00. To investigate whether routine pretransfusion blood sampling for trauma admissions exceeds requirements.BACKGROUND
AIM
The number of revision hip arthroplasty procedures is rising annually with 7852 such operations performed in the UK in 2010. These are expensive procedures due to pre-operative investigation, surgical implants and instrumentation, protracted hospital stay, and pharmacological costs. There is a paucity of robust literature on the costs associated with the common indications for this surgery. We aim to quantify the cost of revision hip arthroplasty by indication and identify any short-fall in relation to the national tariff.Introduction
Objective
Aims. The burden of revision total hip arthroplasty (rTHA) continues to grow. The surgery is complex and associated with significant costs. Regional rTHA networks have been proposed to improve outcomes and to reduce re-revisions, and therefore costs. The aim of this study was to accurately quantify the cost and reimbursement for a rTHA service, and to assess the financial impact of case complexity at a tertiary referral centre within the NHS. Methods. A retrospective analysis of all revision hip procedures was performed at this centre over two consecutive financial years (2018 to 2020). Cases were classified according to the Revision Hip Complexity Classification (RHCC) and whether they were infected or non-infected. Patients with an American Society of Anesthesiologists (ASA) grade ≥ III or BMI ≥ 40 kg/m. 2. are considered “high risk” by the RHCC. Costs were calculated using the Patient Level Information and Costing System (PLICS), and remuneration based on Healthcare Resource Groups (HRG) data. The primary outcome was the financial difference between tariff and cost per patient episode. Results. In all, 199 revision episodes were identified in 168 patients: 25 (13%) least complex revisions (H1); 110 (55%) complex revisions (H2); and 64 (32%) most complex revisions (H3). Of the 199, 76 cases (38%) were due to infection, and 78 patients (39%) were “high risk”. Median length of stay increased significantly with case complexity from four days to six to eight days (p = 0.006) and for revisions performed for infection (9 days vs 5 days; p < 0.001). Cost per episode increased significantly between complexity groups (p < 0.001) and for infected revisions (p < 0.001). All groups demonstrated a mean deficit but this significantly increased with revision complexity (£97, £1,050, and £2,887 per case; p = 0.006) and for infected failure (£2,629 vs £635; p = 0.032). The total deficit to the NHS Trust over two years was £512,202. Conclusion. Current NHS reimbursement for rTHA is inadequate and should be more closely aligned to complexity. An increase in the most complex rTHAs at major revision centres will likely place a greater
Purpose: To meet the increasing demand for arthroplasty in Canada healthcare providers are investigating efficiency improvements to maximize utilization of limited surgical resources. One target is routine annual arthroplasty follow-up for which there are no established guidelines. A previous study by the authors revealed that 52% of arthroplasty patients could be followed with standardized questionnaires and x-rays resulting in a 30% savings to the healthcare system. In this study we report the patient time, travel and
Aim. The number of periprosthetic joint infections (PJI) is increasing due to ageing population and increasing numbers of arthroplasty procedures and treatment is costly. Aim of the study was to analyze the direct healthcare costs of PJI in Europe for total hip arthroplasties (THA) and total knee arthroplasties (TKA). Method. A systematic review in PubMed with search of direct costs of PJI in European countries was performed. Thereby the term cost* AND (infection OR PJI) AND (prosthesis OR knee OR hip OR “TKA” OR “THA” OR arthroplast*) was combined with each European country to detect relevant publications. Publications with definition of performed procedure and joint localization were included into further analysis. The mean value of direct healthcare cost was calculated for the respective joint and the respective operation performed. Results. Screening revealed 1,274 eligible publications. After review of abstracts and full-texts n=11 manuscripts were included into final analysis (Figure 1). The mean combined direct hospital costs for revision for PJI after TKA and THA was 26,311€. Mean costs for revision procedures for PJI after TKA were 24,617€. Direct costs for TKA-PJI treated with debridement, antibiotics and implant retention (DAIR) were on average 10,121€. For two-stage revisions in knee arthroplasties total average costs were 30,829€. Referring to revision surgery for PJI in THA, the mean hospital costs in Europe were 28,005€. For a DAIR procedure direct healthcare costs of 5,528€ were identified. Two-stage revision cost on average 31,217€. Conclusions. PJIs are associated with significant direct healthcare costs. The
Advances in total hip and knee replacement technologies have heretofore been largely driven by corporate marketing hype with each seeming advancement accompanied by a cost increase often out in front of peer-reviewed reports documenting their efficacy or not. As example, consider the growing use of ceramic femoral heads in primary total hip arthroplasty (THA). The question to consider is “Can an upcharge of $350 for a ceramic femoral head in primary THA be justified?” The answer to this question lies in an appreciation of whether the technology modifies the potential for costly revision arthroplasty procedures. Peer-Reviewed Laboratory & Clinical Review - According to the 2022 Australian National Joint Replacement Registry, the four leading causes of primary THA failure requiring revision are: 1.) infection, 2.) dislocation/instability, 3.) periprosthetic fracture and 4.) loosening, which constitute 87.5% of the reported reasons for revision. Focusing on these failure modes, hip simulator findings report that ceramic femoral heads dramatically reduce wear debris generation, decreasing the potential for osteolytic response leading to loosening. Further, ceramic materials enable the utilization of larger head sizes, avoiding the potential for dislocation. The overall mid- to long-term survival rate reported in the peer-reviewed, clinical literature for these bearings has exceeded 95% with virtually no osteolysis. Also, could bearing surface choice influence periprosthetic joint infection (PJI)? A study on a total of more than 10,500 primary THA procedures reported a confirmed PJI incidence of 2.4% for cobalt-chrome and 1.6% for ceramic femoral heads, suggesting that the employ of a ceramic bearing surface may also play a role in decreasing the potential for infection. Review of the clinical data available for ceramic bearings justifies that it is better to “pay me now than to pay orders of magnitude later”, if in fact a revision THA can be avoided, significantly reducing the overall
Introduction. Knee arthroplasty (KA), encompassing Total Knee Replacement (TKR) and Unicompartmental Knee Replacement (UKR), is one of the most common orthopedic procedures, aimed at alleviating severe knee arthritis. Postoperative KA management, especially radiographic imaging, remains a substantial
Introduction. The knee is the most commonly injured joint in sporting accidents, leading to substantial disability, time off work and morbidity (1). Treatment and assessment vary around the UK (2), whilst there remains a limited number of high-quality randomised controlled trials assessing first time, acute soft tissue knee injuries (3,4). As the clinical and
Aims. The present study aimed to investigate whether patients with inflammatory bowel disease (IBD) undergoing joint arthroplasty have a higher incidence of adverse outcomes than those without IBD. Methods. A comprehensive literature search was conducted to identify eligible studies reporting postoperative outcomes in IBD patients undergoing joint arthroplasty. The primary outcomes included postoperative complications, while the secondary outcomes included unplanned readmission, length of stay (LOS), joint reoperation/implant revision, and cost of care. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model when heterogeneity was substantial. Results. Eight retrospective studies involving 29,738 patients with IBD were included. Compared with non-IBD controls, patients with IBD were significantly more likely to have overall complications (OR 2.11 (95% CI 1.67 to 2.66), p < 0.001), medical complications (OR 2.15 (95% CI 1.73 to 2.68), p < 0.001), surgical complications (OR 1.43 (95% CI 1.21 to 1.70), p < 0.001), and 90-day readmissions (OR 1.42 (95% CI 1.23 to 1.65), p < 0.001). The presence of IBD was positively associated with the development of venous thromboembolism (OR 1.60 (95% CI 1.30 to 1.97), p < 0.001) and postoperative infection (OR 1.95 (95% CI 1.51 to 2.51), p < 0.001). In addition, patients with IBD tended to experience longer LOS and higher costs of care. Conclusion. The findings suggest that IBD is associated with an increased risk of postoperative complications and readmission after joint arthroplasty, resulting in longer hospital stay and greater
Introduction. Non-union is an unfortunate outcome of the fracture healing process for some patients; with an estimated annual incidence of 17.4- 18.9 per 100,00. The management of these patients depicts a significant clinical challenge for surgeons and
Aims. Advances in surgical technique and implant design may influence the incidence and mechanism of failure resulting in revision total hip arthroplasty (rTHA). The purpose of the current study was to characterize aetiologies requiring rTHA, and to determine whether temporal changes existed in these aetiologies over a ten-year period. Methods. All rTHAs performed at a single institution from 2009 to 2019 were identified. Demographic information and mode of implant failure was obtained for all patients. Data for rTHA were stratified into two time periods to assess for temporal changes: 2009 to 2013, and 2014 to 2019. Operative reports, radiological imaging, and current procedural terminology (CPT) codes were cross-checked to ensure the accurate classification of revision aetiology for each patient. Results. In all, 2,924 patients with a mean age of 64.6 years (17 to 96) were identified. There were 1,563 (53.5%) female patients, and the majority of patients were Caucasian (n = 2,362, 80.8%). The three most frequent rTHA aetiologies were infection (27.2%), aseptic loosening (25.2%), and wear (15.2%). The frequency of rTHA for adverse local tissue reaction (ALTR) was significantly greater from 2014 to 2019 (4.7% vs 10.0%; p < 0.001), while the frequency of aseptic loosening was significantly greater from 2009 to 2013 (28.6% vs 21.9%; p < 0.001). Conclusion. Periprosthetic joint infection was the most common cause for rTHA in the current cohort of patients. Complications associated with ALTR necessitating rTHA was more frequent between 2014 to 2019, while aseptic loosening necessitating rTHA was significantly more frequent between 2009 to 2013. Optimizing protocols for prevention and management of infection and ALTR after THA may help to avoid additional
Revision total hip arthroplasty (rTHA) can be complex and associated with significant cost, with an increasing burden within the UK and globally. Regional rTHA networks have been proposed aiming to improve outcomes, reduce re-revisions and therefore costs. The aim of this study was to accurately quantify the cost and reimbursement for the rTHA service and to assess the financial impact of case complexity at a tertiary referral centre within the NHS. A retrospective analysis of all revision hip procedures was performed over two consecutive financial years (2018–2020). Cases were classified according to the Revision Hip Complexity Classification (RHCC) and by mode of failure; infected or non-infected. Patients of ASA grade of 3 or greater or BMI over 40 are considered “high-risk” by the RHCC. Costs were calculated using PLICS and remuneration based on the HRG data. The primary outcome was the financial difference between tariff and cost per episode per patient. Comparisons between groups were analysed using analysis of variance and two-tailed unpaired t-test. 199 revision episodes were identified in 168 patients: 25 (13%) least complex revisions (H1), 110 (55%) complex revisions (H2) and 64 (32%) most complex revisions (H3). 76 (38%) cases were due to infection. 78 (39%) of patients were in the “high-risk” group. Median length of stay increased with case complexity from 4, to 6 to 8 days (p=0.17) and significantly for revisions performed for infection (9 vs 5 days; p=0.01). Cost per episode increased significantly between complexity groups (p=0.0002) and for infected revisions (p=0.003). All groups demonstrated a mean deficit, but this significantly increased with revision complexity (£301, £1,820 and £4,757 per case; p=0.02) and for infected failure (£4,023 vs £1,679; p=0.02). The total deficit to the trust for the two-years was £512,202. Current NHS reimbursement for rTHA is inadequate and should be more closely aligned to complexity. An increase in the most complex rTHA at major revision centres (MRC) will likely place a greater
Background:. Injuries inflicted by gunshot wounds (GSW) are an immense
Aims. The primary aim is to estimate the current and potential number of patients on NHS England orthopaedic elective waiting lists by November 2020. The secondary aims are to model recovery strategies; review the deficit of hip and knee arthroplasty from National Joint Registry (NJR) data; and assess the cost of returning to pre-COVID-19 waiting list numbers. Methods. A model of referral, waiting list, and eventual surgery was created and calibrated using historical data from NHS England (April 2017 to March 2020) and was used to investigate the possible consequences of unmet demand resulting from fewer patients entering the treatment pathway and recovery strategies. NJR data were used to estimate the deficit of hip and knee arthroplasty by August 2020 and NHS tariff costs were used to calculate the
Abstract. Objectives. Up to 19% of patients who undergo surgery for an acute hip fracture are readmitted to the hospital within three months of the index operation. We aimed to identify risk factors for unplanned clinic attendance, readmission, and mortality within the first 12 months postoperatively and subsequently determine if there is a role for routine follow-up. Methods. Patients greater than 65 years old who underwent hip hemiarthroplasty using an uncemented Thompson implant for treatment of a traumatic non-pathological hip fracture were identified from a prospectively maintained database at a single institution between August 2007 and February 2011. Patient demographics, comorbidities, place of residence, mobility status, unplanned attendance to an orthopaedic clinic with symptoms relating to the respective limb, readmission, and mortality were recorded. Results. Five hundred and fifty-four consecutive patients were identified. Unplanned clinic attendance was correlated to age (p = 0.000, B = −0.0159, 95% confidence interval (CI): −0.200 to −0.65), with patients between the ages of 65 – 70 years most likely to require unplanned clinic review postoperatively. The American Society of Anesthesiologists (ASA) grade (p = 0.019, 95% CI: 0.014 to 0.163) and frequency of unplanned outpatient attendance (p = 0.000, 95% CI: 0.120 to 0.284) were significantly associated with increased readmission within 12 months of the index procedure with patients who were regarded as ASA > 2 most likely to require readmission within the first postoperative year. Conclusion. To our knowledge, this is the first piece of research that identifies causative factors for unplanned clinic attendance and acute readmission during the first postoperative year in acute hip fracture patients treated by hemiarthroplasty. Routine scheduled follow-up of patients based on risk stratification may be effective in reducing the
Introduction and Objective. Hip fractures represent one of the most challenging injuries in orthopaedic practice due to the associated morbidity, mortality and the
Acute pain is one of the most common symptoms shared among patients who have suffered from an orthopedic trauma such as an isolated upper limb fracture (IULF). Development of interventions with limited side effects aiming to prevent the installation of chronic pain is critical as persistent pain is associated with an increased risk of opioid dependence, medical complications, staggering
Surgical site infections (SSIs) are associated with significant consequences in orthopaedic surgery, where their presence can lead to ultimate revision of the implant. Furthermore, infections and impaired wound healing can prolong length of hospital stay following orthopaedic surgery, which can place additional