title: A cost analysis of single-stage bilateral versus two-stage direct anterior total hip arthroplasty.
abstract: OBJECTIVE
  The potential cost savings of single-stage bilateral total hip arthroplasty (THA) are unclear, and the risks associated with it are not well defined. We sought to compare the costs and perioperative complications of single-stage bilateral THA via the direct anterior approach (DAA) to a two-stage bilateral protocol.
  
  
  METHODS
  We retrospectively reviewed patients who underwent a single- stage bilateral DAA THA and compared them to a two-stage THA group. We conducted a cost analysis from both the hospital perspective and the Ministry of Health (MOH) perspective.
  
  
  RESULTS
  24 patients were included in this study. The 2 groups were similar in age (58.9 vs 63.9 yrs), height (169.2 vs 170.9 cm), weight (80.2 vs 78.6 kg), BMI (27.9 vs 26.3 kg/m2), ASA score (2.2 vs 2.2), and CCI score (2.3 vs 2.9). The mean cost per patient from the hospital perspective for the single-stage group was $10,728.13 (SD = 621.46) compared to $12,670.63 (SD = 519.72) for the two-stage group (Mean Difference = $1,942.50, 95% CI = $1,457.49 to $2,427.51, p&lt;0.001). Similarly, from the MOH perspective, the cost for the single-stage group was $12,552.34 (SD = 644.93) compared to $14,740.58 (SD = 598.07) for the two-stage group (Mean Difference = $2,188.24, 95% CI = $1,661.67 to $2,714.81, p&lt;0.001). There were no significant differences in complication rate between groups. The largest percent of total cost savings from a hospital perspective was attributed to cost of operating room staff and OR set-up (55%).
  
  
  CONCLUSIONS
  Our results suggest that single-stage bilateral DAA THA results in significant cost savings compared to two-stage DAA THA.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, London, Ontario - Canada.
authors.forename: Glynn R
authors.initials: GR
authors.lastname: Martin
authors.affiliation: Faculty of Health Sciences, Schulich School of Medicine and Dentistry, London, Ontario - Canada.
authors.forename: Jacquelyn D
authors.initials: JD
authors.lastname: Marsh
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, London, Ontario - Canada.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Vasarhelyi
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, London, Ontario - Canada.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Howard
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, London, Ontario - Canada.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Lanting
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D015207:Osteoarthritis, Hip / Q000191:economics / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome