Inpatient Cost of Complications After Total Hip and Knee Arthroplasty.
Academic Article
Overview
abstract
BACKGROUND: Over 1 million hip and knee total joint arthroplasties (THA and TKA) are performed annually in the US. While major perioperative complications are relatively uncommon, they may substantially increase healthcare expenditures. The economic impact of individual complications, however, remains poorly defined. We aimed to assess the effect of major complications on hospital costs and length of stay (LOS). METHODS: We analyzed data from 2,361,402 THA/TKA patients in the Premier Healthcare claims database (2006-2022). The exposure was the occurrence of major postoperative complications (e.g. cardiac, pulmonary, renal, gastrointestinal, infectious, central nervous system, and thromboembolic complications), evaluated individually and in clusters (2 or ≥3 coinciding). The primary outcome was total cost of hospital stay. Generalized estimating equation models compared costs across groups, reported as percent change with 95% confidence intervals. RESULTS: Median costs without complications were $16,802 (IQR $13,731-$20,838) for TKA and $17,250 (IQR $14,072-$21,355) for THA. In TKA, highest costs occurred with ≥3 complications ($35,477, IQR $26,078-$52,071), sepsis ($30,633, IQR $21,748-$44,530), and myocardial infarction ($28,908, IQR $21,805-$38,744). Multivariable models confirmed the greatest adjusted increases with ≥3 complications (+136%), sepsis (+88%), and myocardial infarction (+73%) at the patient level. Frequent complications such as renal failure (+26%), pulmonary complications (+23%), and ICU admission (+61%) emerged as leading drivers of overall costs. LOS accounted for a substantial share of additional costs. CONCLUSIONS: In this large national cohort, perioperative complications substantially increased hospital costs, largely via prolonged LOS. Although sepsis, stroke, and myocardial infarction were most expensive per case, the overall healthcare burden was driven by frequent complications and resource use, including ICU admission, acute renal failure, pulmonary complications, mechanical ventilation, and concurrent complications. These findings suggest that targeting frequent complications and resource intensive care processes may yield the greatest impact on reducing hospital expenditures in arthroplasty surgery.
