There is No Difference in Outpatient Costs Within One Year Post-Total Hip Arthroplasty when Comparing Surgical Approach.

Abstract

Total hip arthroplasty (THA) continues to be a substantial financial burden to the Canadian healthcare system. However, there has been no evaluation of cost or resources used in the outpatient setting. The purpose of this study was to determine the impact of surgical approach on the associated outpatient cost of THA. Patients who underwent a THA via an anterior, posterior, or lateral approach were recruited (the study was not randomized). All patients prospectively completed a cost diary (self-reported use of allied health services, investigations, clinic visits, patient expenses, and number of employment days lost to THA) to estimate total resource use and patient expenses incurred after discharge. Group comparisons were performed using Pearson's Chi-squares and one-way analyses of variance (ANOVA); significance was accepted at P ≤ 0.05. A prospective, micro-costing analysis was performed on 104 patients undergoing a THA through either an anterior (n = 37), posterior (n = 32), or lateral (n = 35) approach for one year postoperatively. The overall costs of outpatient resources and expenses were comparable between anterior ($1,321.00 CDN), posterior ($1,094.92 CDN), and lateral ($1,153.18 CDN) approaches (P = 0.114). When the overall costs were stratified by specific expenses, the costs of allied health services were significantly higher in the anterior group ($361.32 CDN; 95% confidence interval (CI), 257.58 to 465.07) when compared to the posterior group ($206.50 CDN; 95% CI, 124.50 to 288.50, P = 0.028). This correlated with a higher number of average nursing care visits for the anterior group compared to both the posterior and lateral groups (P = 0.001). There were no differences in costs of clinic visits, investigations, or number of employment days lost to THA. Cost analysis on the effect of surgical approach for THA in outpatient resources and expenses resulted in comparable overall costs between the anterior, posterior, and lateral approaches. Future directions include capturing long-term effectiveness measures to perform a cost-effectiveness analysis from a societal perspective.