title: Impact of Anterior vs Posterior Approach for Total Hip Arthroplasty on Post-Acute Care Service Utilization.
abstract: Controversy exists as to which surgical approach is best for total hip arthroplasty (THA). Previous studies suggested that the tissue-sparing anterior approach should result in a more rapid recovery requiring fewer postacute services, ultimately decreasing overall episodic cost. The purpose of this cross-sectional study was to determine if any significant differences exist between the anterior vs posterior approaches on postacute care service utilization, readmissions, or episodic cost.
  
  
  
  Claims data from 26,773 Medicare fee-for-service beneficiaries receiving elective THAs (Medical Severity-Diagnosis Related Groups (MS-DRGs) 469/470) were analyzed. Claims data were collected from the 2-year period, January 2013 through December 2014. The posterior surgical approach was performed on 23,653 patients while 3120 patients received the anterior approach.
  
  
  
  Data analysis showed negligible effect sizes in postacute care service utilization, readmission rate, and cost between the surgical approaches for elective THA (MS-DRG 469 and 470). Average THA total episode cost was negligibly higher for procedures using the anterior approach compared to the posterior approach ($22,517 and $22,068, respectively). Statistically significant differences were observed in inpatient rehab and home health cost and service utilization. However, the effect sizes of these comparisons are negligible when accounting for the large sample size. All other comparisons showed minimal and statistically insignificant variation.
  
  
  
  The results indicate that surgical approach alone is not the primary driver of postacute care service utilization, quality outcomes, or cost. Other factors such as physician-led patient-focused care pathways, care coordination, rapid rehabilitation protocols, perioperative pain management protocols, and patient education are integral for effective patient care.
authors.affiliation: Signature Medical Group, Inc, St. Louis, Missouri.
authors.forename: Coles E
authors.initials: CE
authors.lastname: L'Hommedieu
authors.affiliation: Signature Medical Group, Inc, St. Louis, Missouri.
authors.forename: James J
authors.initials: JJ
authors.lastname: Gera
authors.affiliation: Signature Medical Group, Inc, St. Louis, Missouri.
authors.forename: Gerald
authors.initials: G
authors.lastname: Rupp
authors.affiliation: Signature Medical Group, Inc, St. Louis, Missouri.
authors.forename: Jeffery W
authors.initials: JW
authors.lastname: Salin
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: John S
authors.initials: JS
authors.lastname: Cox
authors.affiliation: Orthopedic and Fracture Specialists, Portland, Oregon.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Duwelius
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures; D018588:Fee-for-Service Plans; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D010359:Patient Readmission; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D019467:Subacute Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
keywords: anterior total hip arthroplasty; economics of total hip arthroplasty; posterior total hip arthroplasty; surgical approach; total hip arthroplasty; total hip outcomes