Cost Analysis of Direct Anterior Versus Direct Lateral Approach for Outpatient Total Hip Arthroplasty: Does Surgical Approach Impact Cost?

Abstract

Background: Total hip arthroplasty (THA) is an effective surgery for advanced osteoarthritis. The rising demand for THA and increasing wait times are having a substantial impact on health care resources, resulting in increased pressure to move to outpatient care. This has most commonly been enabled through a minimally invasive, direct anterior (DA) surgical approach; however, recently, the direct lateral (DL) approach has also been used in outpatient THA. The purpose of this study was to compare costs between outpatient THAs using a DA compared to a DL approach.

Methods: The present study is a secondary analysis of a randomized controlled trial and a prospective cohort study. Participants undergoing primary THA using the DA approach were randomly assigned to be discharged on the same day as surgery (outpatient) or on day one postsurgery (inpatient). The cohort study included patients undergoing outpatient THA using the DL approach. We compared patients in the outpatient arm of the randomized trial to the prospective cohort of outpatient DL THAs. We recorded all costs associated with each surgical approach. Following discharge, participants also completed a self-reported cost diary regarding any resource utilization such as emergency department visits or subsequent hospitalizations, tests and procedures, consultations or follow-up, health care professional services, rehabilitation, medications, informal care, productivity losses, and out-of-pocket expenditures up to three months postoperative. There were 127 patients in the DA group and 51 patients in the DL group. The mean age of patients in the DA group was 66 years compared to 59 years in the DL group (P < 0.01).

Results: There were no statistically significant differences in costs between groups from either the health care payer (DA = 7,910.19, DL = 7,847.17, P = 0.80) or societal perspectives (DA = 14,657.21, DL = 14,581.21, P = 0.96).

Conclusions: Our results suggest similar overall mean costs over 90 days postoperative between outpatient THA using a DL or DA surgical approach.

Keywords: cost; direct anterior; direct lateral; outpatient; total hip arthroplasty.