Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement
To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in pati...
| Authors: | ; ; ; ; ; ; ; |
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| Format: | Article |
| Publication date: | 2018 |
| Country: | España |
| Institution: | Universitat Autònoma de Barcelona |
| Repository: | Dipòsit Digital de Documents de la UAB |
| Language: | English |
| OAI Identifier: | oai:ddd.uab.cat:188585 |
| Online Access: | https://ddd.uab.cat/record/188585 https://dx.doi.org/urn:doi:10.1136/bmjopen-2017-019146 |
| Access Level: | Open access |
| Keyword: | Joint replacement Knee arthroplasty Hip arthroplasty Length of stay Costs |
| _version_ | 1878738459608219648 |
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| author | Burn, Edward|||0000-0002-9286-1128 |
| author2 | Edwards, Christopher J. Murray, David W. Silman, Alan Cooper, Cyrus|||0000-0003-3510-0709 Arden, N. K|||0000-0002-3452-3382 Pinedo-Villanueva, Rafael|||0000-0002-4723-5128 Prieto-Alhambra, Daniel|||0000-0002-3950-6346 |
| author2_role | author author author author author author author |
| author_browse | Arden, N. K|||0000-0002-3452-3382 Burn, Edward|||0000-0002-9286-1128 Cooper, Cyrus|||0000-0003-3510-0709 Edwards, Christopher J. Murray, David W. Pinedo-Villanueva, Rafael|||0000-0002-4723-5128 Prieto-Alhambra, Daniel|||0000-0002-3950-6346 Silman, Alan |
| author_facet | Burn, Edward|||0000-0002-9286-1128 Edwards, Christopher J. Murray, David W. Silman, Alan Cooper, Cyrus|||0000-0003-3510-0709 Arden, N. K|||0000-0002-3452-3382 Pinedo-Villanueva, Rafael|||0000-0002-4723-5128 Prieto-Alhambra, Daniel|||0000-0002-3950-6346 |
| author_role | author |
| collection | Dipòsit Digital de Documents de la UAB |
| description | To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Cross-sectional study using routinely collected data. National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Primary TKR, primary THR, revision TKR and revision THR. Length of stay and hospital reimbursement. 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_af5ac2a6721b8c8dd5018ec4e1eefdb6 |
| institution | Universitat Autònoma de Barcelona |
| instname_str | Universitat Autònoma de Barcelona |
| language | eng |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:ddd.uab.cat:188585 |
| publishDate | 2018 |
| publishDateSort | 2018 |
| reponame_str | Dipòsit Digital de Documents de la UAB |
| spelling | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement evidence from linked primary care and NHS hospital records from 1997 to 2014 Burn, Edward|||0000-0002-9286-1128 Edwards, Christopher J. Murray, David W. Silman, Alan Cooper, Cyrus|||0000-0003-3510-0709 Arden, N. K|||0000-0002-3452-3382 Pinedo-Villanueva, Rafael|||0000-0002-4723-5128 Prieto-Alhambra, Daniel|||0000-0002-3950-6346 Joint replacement Knee arthroplasty Hip arthroplasty Length of stay Costs To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Cross-sectional study using routinely collected data. National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Primary TKR, primary THR, revision TKR and revision THR. Length of stay and hospital reimbursement. 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency. https://ddd.uab.cat/record/188585 https://dx.doi.org/urn:doi:10.1136/bmjopen-2017-019146 |
| spellingShingle | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement Burn, Edward|||0000-0002-9286-1128 Joint replacement Knee arthroplasty Hip arthroplasty Length of stay Costs |
| title | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement |
| title_full | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement |
| title_fullStr | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement |
| title_full_unstemmed | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement |
| title_short | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement |
| title_sort | Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement |
| topic | Joint replacement Knee arthroplasty Hip arthroplasty Length of stay Costs |
| topic_facet | Joint replacement Knee arthroplasty Hip arthroplasty Length of stay Costs |
| url | https://ddd.uab.cat/record/188585 https://dx.doi.org/urn:doi:10.1136/bmjopen-2017-019146 |