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. 2018 Jan 27;8(1):e019146.
doi: 10.1136/bmjopen-2017-019146.

Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014

Edward Burn  1 , Christopher J Edwards  2 , David W Murray  1 , Alan Silman  1 , Cyrus Cooper  1   3 , Nigel K Arden  1   3 , Rafael Pinedo-Villanueva  1   3 , Daniel Prieto-Alhambra  1   4
Affiliations

Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014

Edward Burn et al. BMJ Open. .

Abstract

Objectives: To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles.

Design: Cross-sectional study using routinely collected data.

Setting: National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care.

Participants: Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis.

Interventions: Primary TKR, primary THR, revision TKR and revision THR.

Primary outcome measures: Length of stay and hospital reimbursement.

Results: 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included.

Conclusions: Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.

Keywords: costs; hip arthroplasty; joint replacement; knee arthroplasty; length of stay.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare that NKA has received personal fees from Freshfields Bruckhaus Deringer, Bioventus, Flexion, Merck and Regeneron, all outside the submitted work. DPA reports grants from Amgen, Servier and UCB Biopharma, and non-financial support from Amgen, all outside the submitted work. DWM reports grants and personal fees from Zimmer Biomet. In addition, DWM has various patents related to Unicompartmental Knee Replacement (Zimmer Biomet) with royalties paid.

Figures

Figure 1
Figure 1
Study inclusion flow chart. CPRD, Clinical Practice Research Datalink; HES APC, Hospital Episode Statistics Admitted Patient Care; OA, osteoarthritis; RA, rheumatoid arthritis; THR, total hip replacement; TKR, total knee replacement.
Figure 2
Figure 2
Trends in length of stay. Estimated effect of year of surgery on length of stay (in days). THR, total hip replacement; TKR, total knee replacement.
Figure 3
Figure 3
Trends in hospital reimbursement. Estimated effect of year of surgery on hospital reimbursement (at 2016/2017 rates in GBP). THR, total hip replacement; TKR, total knee replacement.
See this image and copyright information in PMC

References

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