Abstract

MANA PASTRIAN, Diego et al. Bilateral total knee replacement: one and two stages. cost analysis. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2010, vol.75, n.2, pp.151-156. ISSN 1852-7434.

Background: One third of all patients undergoing unilateral hip or knee replacement suffer bilateral symptomatic disease. The main purpose of this study was to evaluate and compare the cost of bilateral total knee replacement, in one or two stages, to the patient and / or the health care system. Methods: We included patients operated on for simultaneous bilateral total knee replacement between 2004 and 2008. Also included were 12 patients operated on for bilateral total knee replacement in 2 stages randomly performed. Parameters such as: age, sex, diagnosis, type of surgery, type of anesthesia, length of surgery, type of prosthesis, hospital days, rehabilitation days, transfusions and medications were taken into account. In each case the following were also recorded: return to the OR, ICU stay, discharge to rehabilitation center, readmission within the first 7 days of discharge, and death within thirty days from surgery. We obtained the exact final cost of each procedure. Group A: 13 patients (26 knees). Age: 68.8 years (range 56-78). Diagnosis: Arthritic genu varum (25 knees) and arthritic genu valgus (1 knee). Group B: 12 patients (24 knees). Age: 68.2 years (range 23-94). Diagnosis: Arthritic genu varum (19 knees), rheumatoid arthritis (4 knees) and arthritic genu valgus (1 knee). Results: Implants' cost was the same in both groups: AR pesos 18,000, i.e., AR pesos 9,000 each implant. The cost of transfusions amounted to AR$ 3,560 (AR $ 1,235- 5,815) in the first group and AR $ 3,860 (AR $ 1,055- 6,880) in the second. The cost of OR use was AR$ 2,875 (AR$ 1,680-3,360) for the first group versus AR$ 3,202 (AR$ 2,310-3,780). In group A the average hospitalization cost was AR$ 5,539 (AR$ 4,696-10,958), whereas for group B, the cost was AR$ 9,783 (AR$ 7,040- 20,351). Analyzing the difference, note that the value is nearly twice that of the first group. Hospital rehabilitation cost was AR$ 495 (AR$ 420-980) in group A, and AR$ 873 (AR$ 560-1,820) in group B. Conclusions: In this analysis, the average total hospital cost was AR$ 37,159.69 for those who received a simultaneous TKR compared to AR$ 47,627.5 in patients who underwent the same procedure in two stages. The largest difference was found in: hospitalization time, use of medication and amount of anesthesia. Minor differences appeared in the cost of rehabilitation, clinic follow up and ICU. One of the most significant results is that simultaneous bilateral TKR is a highly cost-effective procedure, which, conducted in patients with bilateral symptomatic disease reduces up to 34% the final costs as compared to 2 separate stages.

Keywords : Bilateral total knee replacement; Cost effectiveness and complications.

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