title: [Total knee and hip prosthesis: variables associated with costs].
abstract: BACKGROUND
  The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery.
  
  
  OBJECTIVE
  To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge.
  
  
  METHODS
  A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver.
  
  
  RESULTS
  The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients.
  
  
  CONCLUSIONS
  There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.
authors.affiliation: Servicio Reanimación de Traumatología, Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain. carmen.herrera.sspa@juntadeandalucia.es
authors.forename: Carmen
authors.initials: C
authors.lastname: Herrera-Espiñeira
authors.forename: Antonio
authors.initials: A
authors.lastname: Escobar
authors.forename: José Luis
authors.initials: JL
authors.lastname: Navarro-Espigares
authors.forename: Juan de Dios Lunadel
authors.initials: Jde D
authors.lastname: Castillo
authors.forename: Lidia
authors.initials: L
authors.lastname: García-Pérez
authors.forename: Amparo
authors.initials: A
authors.lastname: Godoy-Montijano
mesh_terms: D000359:Aftercare / Q000191:economics; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000534:rehabilitation; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006622:Hip Prosthesis / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007720:Knee Prosthesis / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D011446:Prospective Studies; D013030:Spain
keywords: Hip prosthesis; alta del paciente; análisis multinivel; artroplastia de reemplazo; cirugía; costos; costs and cost 
  analysis; economía de la salud; health economics; knee prosthesis; multilevel analysis; patient discharge; prótesis de cadera; prótesis de rodilla; replacement arthroplasty; surgery