Cost of Post-Operative Complications after Total Hip and Total Knee Replacement Surgery

Richardson KK, Vaughan-Sarrazin MS, Cram PM. Cost of Post-Operative Complications after Total Hip and Total Knee Replacement Surgery. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.

Related HSR&D Project(s)

• IIR 08-067 – Organizational Factors and Inpatient Medical Care

Objectives: Surgical complications contribute significantly to costs. Most importantly, surgical complications contribute to morbidity and mortality and some may be preventable. It is estimated that the number of total knee and total arthroplastics performed in the United States will increase by approximately 6-fold by 2030. This study estimates costs of specific surgical complications for patients undergoing knee or hip replacement surgery in VA hospitals using merged data from the VA Surgical Quality Improvement Program (VASQIP) and VA Decision Support System (DSS). Methods: Costs associated with 19 potentially preventable complications within six broader categories were estimated using generalized linear mixed regression models to control for patient-level determinants of costs (e.g., type of surgery, demographics, comorbidity, severity) and hospital-level variation in costs. Hospital-level variation was accounted for by including a random intercept into generalized linear mixed models. Costs included costs of the index hospitalization and subsequent 30 day readmissions. Results: In 6,453 patients undergoing knee and hip replacement procedures from 10/2005 through 9/2006, 7.8% of patients developed postoperative surgical complications. The presence of any complication significantly increased unadjusted costs ($23,760 vs. $36,008), with the largest cost differential attributed to respiratory complications. Patients who developed complications had several markers for greater pre-operative severity, including increased age, emergency status, lab values and comorbid conditions. After controlling for differences in patient severity, costs for patients with any complication were 1.33 (p < .0001) times greater compared to costs for patients with no complications. Within major complication categories, adjusted costs were significantly higher for patients with respiratory, cardiac, central nervous system, urinary, wound, or other complications. Implications: Surgical complications contribute significantly to costs of inpatient hip and knee replacement surgeries. Investment in quality improvement that reduces surgical complications could decrease costs. Impacts: These findings point to the importance of preventing surgical complications, particularly, for hip and knee replacement surgeries which are prevalent in VA.