title: Financial analysis of revision knee surgery based on NHS tariffs and hospital costs: does it pay to provide a revision service?
abstract: Revision total knee arthroplasty (TKA) is a complex procedure which carries both a greater risk for patients and greater cost for the treating hospital than does a primary TKA. As well as the increased cost of peri-operative investigations, blood transfusions, surgical instrumentation, implants and operating time, there is a well-documented increased length of stay which accounts for most of the actual costs associated with surgery. We compared revision surgery for infection with revision for other causes (pain, instability, aseptic loosening and fracture). Complete clinical, demographic and economic data were obtained for 168 consecutive revision TKAs performed at a tertiary referral centre between 2005 and 2012. Revision surgery for infection was associated with a mean length of stay more than double that of aseptic cases (21.5 vs 9.5 days, p < 0.0001). The mean cost of a revision for infection was more than three times that of an aseptic revision (£30 011 (sd 4514) vs £9655 (sd 599.7), p < 0.0001). Current NHS tariffs do not fully reimburse the increased costs of providing a revision knee surgery service. Moreover, especially as greater costs are incurred for infected cases. These losses may adversely affect the provision of revision surgery in the NHS.
authors: University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK.
authors: R F
authors: RF
authors: Kallala
authors: Royal National Orthopaedic Hospital Stanmore, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors: I S
authors: IS
authors: Vanhegan
authors: University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK.
authors: M S
authors: MS
authors: Ibrahim
authors: University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK.
authors: S
authors: S
authors: Sarmah
authors: University College London Hospitals, 235 Euston Rd, London NW1 2BU, UK.
authors: F S
authors: FS
authors: Haddad
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007720:Knee Prosthesis / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000191:economics* / Q000601:surgery*; D012086:Reoperation / Q000191:economics; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom
keywords: Arthroplasty; Financial analysis; Knee; Revision