Medical Comorbidities Impact the Episode-of-Care Reimbursements of Total Hip Arthroplasty.
Total hip arthroplasty (THA) costs are a source of great interest in the currently evolving health care market. The initiation of a bundled payment system has led to further research into costs drivers of this commonly performed procedure. One aspect that has not been well studied is the effect of comorbidities on the reimbursements of THA. The purpose of this study was to determine if common medical comorbidities affect these reimbursements.



A retrospective, level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary THA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using the analysis of variance for reimbursements of the day of surgery, and over the 90-day postoperative period.



A cohort of 250,343 patients was identified. Greatest reimbursements on the day of surgery were found among patients with a history of cirrhosis, morbid obesity, obesity, chronic kidney disease (CKD) and hepatitis C. Patients with cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD incurred in the greatest reimbursements over the 90-day period after surgery.



Medical comorbidities significantly impact reimbursements, and inferentially costs, after THA. The most costly comorbidities at 90 days include cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD.
Department of Orthopedic Surgery, University of Miami, Miami, Florida; Department of Orthopedic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida.
Samuel
S
Rosas
Department of Orthopedic Surgery, University of Miami, Miami, Florida.
Karim G
KG
Sabeh
Department of Orthopedic Surgery, University of Miami, Miami, Florida.
Leonard T
LT
Buller
Department of Orthopedic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida.
Tsun Yee
TY
Law
Department of Orthopedic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida.
Martin W
MW
Roche
Department of Orthopedic Surgery, University of Miami, Miami, Florida.
Victor H
VH
Hernandez
D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D015897:Comorbidity; D017050:Episode of Care; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies
bundle payment; comorbidities; costs; reimbursements; total hip arthroplasty