Quantifying and Predicting Surgeon Work Input in Primary vs Revision Total Hip Arthroplasty.

Authors:
Mark J Isaacson
Mark J Isaacson
Houston Methodist Orthopedics & Sports Medicine
Houston | United States
Kevin J Bunn
Kevin J Bunn
Houston Methodist Orthopedics & Sports Medicine
Houston | United States
Philip C Noble
Philip C Noble
Institute of Orthopedic Research and Education
United States
Sabir K Ismaily
Sabir K Ismaily
Institute of Orthopedic Research and Education
United States
Stephen J Incavo
Stephen J Incavo
Houston Methodist Hospital
Houston | United States

J Arthroplasty 2016 06 9;31(6):1188-1193. Epub 2015 Dec 9.

Houston Methodist Orthopedics and Sports Medicine, Houston, Texas.

Background: Primary total hip arthroplasties (THAs) performed annually are projected to increase 174% by 2030, causing a parallel increase for revision THA. Increased surgical effort and readmission rates associated with revision THA may discourage surgeons from performing them. Although revision THA Medicare reimbursement is greater, it may be disproportionate to time and effort. We examined work input between primary and revision THA, assessing predictive factors. We also compared surgeon work input to current reimbursement.

Methods: A total of 156 patients were identified, 80 primary and 76 revision THA. Demographic, clinical, and radiographic data were collected. Radiographic data were collected from the most recent preoperative radiographs taken before primary or revision THA. Multiple linear and logistic regression models were used to identify patient factors contributing to select outcome variables by a stepwise method, with a probability value for entry (P = .05) and removal (P = .10). Residual analysis was performed, confirming validity of these models.

Results: Average age, body mass index, and percentage of female patients were similar between cohorts. There was no statistically significant difference between the demographic variables, although data revealed patient variables contributing to statistically significant increases in surgical time, length of stay, blood loss, and complications with revision THA.

Conclusion: Despite a 66% increase in "percent effort" and 3-fold higher readmission rate, revision THA requires at least a 2-fold increase because of nonquantifiable factors. Revision THA demonstrates a substantial increase in work effort not commensurate with current Medicare reimbursement, which may force surgeons to limit or eliminate revision arthroplasties performed reducing access to patient care.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S08835403150106
Publisher Site
http://dx.doi.org/10.1016/j.arth.2015.11.042DOI Listing

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June 2016
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