Abstract
Medical comorbidities have been shown to cause an increase in peri-and postoperative
complications following total knee arthroplasty (TKA). However, the increase in cost
associated with these complications has yet to be determined. Factors that influence
cost have been of great interest particularly after the initiation of bundled payment
initiatives. In this study, we present and quantify the influence of common medical
comorbidities on the cost of care in patients undergoing primary TKA. A retrospective
level of evidence III study was performed using the PearlDiver supercomputer to identify
patients who underwent primary TKA between 2007 and 2015. Patients were stratified
by medical comorbidities and compared using analysis of variance for reimbursements
for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients
was identified as having undergone primary TKA between 2007 and 2015. The mean entire
episode-of-care reimbursement was $23,701 (range: $21,294–26,299; standard deviation
[SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive
pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766),
morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361),
and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact
reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative
optimization for patients with medical comorbidities undergoing TKA is highly recommended
and may reduce perioperative complications, improve patient outcome, and ultimately
reduce cost.
Keywords
total knee arthroplasty - replacement - medical comorbidities - cost - reimbursement
- bundled payment
