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Comparative Study
. 2016 Feb;31(2):362-7.
doi: 10.1016/j.arth.2015.08.014. Epub 2015 Aug 29.

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Garwin Chin  1 , David J Wright  1 , Nimrod Snir  2 , Ran Schwarzkopf  3
Affiliations
Comparative Study

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Garwin Chin et al. J Arthroplasty. 2016 Feb.

Abstract

Introduction: Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA.

Methods: Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis.

Results: Conversion and primary THAs were determined to be significantly different (P<.05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater).

Conclusions: Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.

Keywords: conversion total hip arthroplasty; cost; implant cost; primary total hip arthroplasty; revision total hip arthroplasty.

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Conflict of interest statement

One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2015.08.014.

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