The economic implications of a multimodal analgesic regimen combined with minimally invasive orthopedic surgery: A comparative cost study

Christopher M. Duncan, Kirsten Hall Long, David Oman Warner, Mark Pagnano, James R. Hebl

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5 Citations (Scopus)

Abstract

Objectives: To evaluate the economic impact of the combined effect of minimally invasive surgery (MIS) and a multimodal analgesia regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing total knee arthorplasty (TKA) or total hip arthroplasty (THA). Patients and Methods: A retrospective cohort, cost comparison study from the hospital prospective was performed on Mayo Clinic patients (n=37) undergoing MIS TKA or THA using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional surgical and anesthetic (non- TJRA) techniques. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups and a subgroup analysis was performed based upon ASA physical status classification. Results: The estimated mean direct medical costs were significantly reduced among MIS with TJRA patients compared to controls (cost difference: $4582; 95% CI $3299-$5864; P <.001). A significant reduction was found in both the hospital-based (Medicare Part A) costs and the physician-based (Medicare Part B) costs. Conclusions: The combined use of minimally invasive surgical (MIS) approaches and a multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement provides a significant reduction in the estimated mean medical costs. A significant reduction occurs in both the hospital based (Medicare Part A) and the physician based (Medicare Part B) costs. In subgroup analysis, the greatest difference was found among the patients with significant comorbidities (ASA III-IV patients).

Original languageEnglish (US)
JournalJournal of Anesthesia and Clinical Research
Volume1
Issue number1
DOIs
StatePublished - Oct 2010

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Minimally Invasive Surgical Procedures
Orthopedics
Analgesics
Economics
Conduction Anesthesia
Costs and Cost Analysis
Medicare Part A
Joints
Critical Pathways
Physicians
Arthroplasty
Hip
Knee
Replacement Arthroplasties
Cost Control
Hospital Costs
Salaries and Fringe Benefits
Economic Inflation
Medicare
Analgesia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

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title = "The economic implications of a multimodal analgesic regimen combined with minimally invasive orthopedic surgery: A comparative cost study",
abstract = "Objectives: To evaluate the economic impact of the combined effect of minimally invasive surgery (MIS) and a multimodal analgesia regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing total knee arthorplasty (TKA) or total hip arthroplasty (THA). Patients and Methods: A retrospective cohort, cost comparison study from the hospital prospective was performed on Mayo Clinic patients (n=37) undergoing MIS TKA or THA using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional surgical and anesthetic (non- TJRA) techniques. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups and a subgroup analysis was performed based upon ASA physical status classification. Results: The estimated mean direct medical costs were significantly reduced among MIS with TJRA patients compared to controls (cost difference: $4582; 95{\%} CI $3299-$5864; P <.001). A significant reduction was found in both the hospital-based (Medicare Part A) costs and the physician-based (Medicare Part B) costs. Conclusions: The combined use of minimally invasive surgical (MIS) approaches and a multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement provides a significant reduction in the estimated mean medical costs. A significant reduction occurs in both the hospital based (Medicare Part A) and the physician based (Medicare Part B) costs. In subgroup analysis, the greatest difference was found among the patients with significant comorbidities (ASA III-IV patients).",
author = "Duncan, {Christopher M.} and Long, {Kirsten Hall} and Warner, {David Oman} and Mark Pagnano and Hebl, {James R.}",
year = "2010",
month = "10",
doi = "10.4172/2155-6148.1000101",
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journal = "Journal of Anesthesia and Clinical Research",
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T1 - The economic implications of a multimodal analgesic regimen combined with minimally invasive orthopedic surgery

T2 - A comparative cost study

AU - Duncan, Christopher M.

AU - Long, Kirsten Hall

AU - Warner, David Oman

AU - Pagnano, Mark

AU - Hebl, James R.

PY - 2010/10

Y1 - 2010/10

N2 - Objectives: To evaluate the economic impact of the combined effect of minimally invasive surgery (MIS) and a multimodal analgesia regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing total knee arthorplasty (TKA) or total hip arthroplasty (THA). Patients and Methods: A retrospective cohort, cost comparison study from the hospital prospective was performed on Mayo Clinic patients (n=37) undergoing MIS TKA or THA using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional surgical and anesthetic (non- TJRA) techniques. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups and a subgroup analysis was performed based upon ASA physical status classification. Results: The estimated mean direct medical costs were significantly reduced among MIS with TJRA patients compared to controls (cost difference: $4582; 95% CI $3299-$5864; P <.001). A significant reduction was found in both the hospital-based (Medicare Part A) costs and the physician-based (Medicare Part B) costs. Conclusions: The combined use of minimally invasive surgical (MIS) approaches and a multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement provides a significant reduction in the estimated mean medical costs. A significant reduction occurs in both the hospital based (Medicare Part A) and the physician based (Medicare Part B) costs. In subgroup analysis, the greatest difference was found among the patients with significant comorbidities (ASA III-IV patients).

AB - Objectives: To evaluate the economic impact of the combined effect of minimally invasive surgery (MIS) and a multimodal analgesia regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing total knee arthorplasty (TKA) or total hip arthroplasty (THA). Patients and Methods: A retrospective cohort, cost comparison study from the hospital prospective was performed on Mayo Clinic patients (n=37) undergoing MIS TKA or THA using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional surgical and anesthetic (non- TJRA) techniques. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups and a subgroup analysis was performed based upon ASA physical status classification. Results: The estimated mean direct medical costs were significantly reduced among MIS with TJRA patients compared to controls (cost difference: $4582; 95% CI $3299-$5864; P <.001). A significant reduction was found in both the hospital-based (Medicare Part A) costs and the physician-based (Medicare Part B) costs. Conclusions: The combined use of minimally invasive surgical (MIS) approaches and a multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement provides a significant reduction in the estimated mean medical costs. A significant reduction occurs in both the hospital based (Medicare Part A) and the physician based (Medicare Part B) costs. In subgroup analysis, the greatest difference was found among the patients with significant comorbidities (ASA III-IV patients).

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