TY - JOUR
T1 - The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery
T2 - A comparative study of direct costs
AU - Duncan, Christopher M.
AU - Long, Kirsten Hall
AU - Warner, David O.
AU - Hebl, James R.
PY - 2009/7
Y1 - 2009/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=70350157756&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70350157756&partnerID=8YFLogxK
U2 - 10.1097/AAP.0b013e3181ac7f86
DO - 10.1097/AAP.0b013e3181ac7f86
M3 - Article
C2 - 19574862
AN - SCOPUS:70350157756
SN - 1098-7339
VL - 34
SP - 301
EP - 307
JO - Regional Anesthesia and Pain Medicine
JF - Regional Anesthesia and Pain Medicine
IS - 4
ER -