The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: A comparative study of direct costs

Christopher M. Duncan, Kirsten Hall Long, David O. Warner, James R. Hebl

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

Background and Objectives: Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. Methods: An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, sex, surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. 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 on ASA PS classification. Results: The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, $1999; 95% confidence interval, $584-$3231; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings.

Original languageEnglish (US)
Pages (from-to)301-307
Number of pages7
JournalRegional Anesthesia and Pain Medicine
Volume34
Issue number4
DOIs
StatePublished - Jul 1 2009

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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