title: Resource utilization and costs before and after total joint arthroplasty.
abstract: BACKGROUND
  The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.).
  
  
  METHODS
  Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test.
  
  
  RESULTS
  14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both p < 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs. $9,632, p < 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs. $1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs. $1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs. $4571, p < 0.01). Mean total costs for the peri-operative period were $36,553.
  
  
  CONCLUSIONS
  Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.
authors.affiliation: University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143-0728, USA. Kevin.bozic@ucsf.edu
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.forename: Brett
authors.initials: B
authors.lastname: Stacey
authors.forename: Ariel
authors.initials: A
authors.lastname: Berger
authors.forename: Alesia
authors.initials: A
authors.lastname: Sadosky
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000145:classification / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000145:classification / Q000191:economics*; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology