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 (University of Oxford. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (UK))
Edwards, Christopher J. (University Hospital Southampton NHS Foundation Trust (Regne Unit))
Murray, David W. (University of Oxford. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (UK))
Silman, Alan (University of Oxford. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (UK))
Cooper, Cyrus (University of Oxford. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (UK))
Arden, N. K (University of Oxford. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (UK))
Pinedo-Villanueva, Rafael (University of Oxford. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (UK))
Prieto-Alhambra, Daniel (Universitat Autònoma de Barcelona)

Fecha:	2018
Resumen:	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.
Nota:	Altres ajuts: DPA is funded by a National Institute for Health Research Clinician Scientist award (CS-2013-371 13-012). This work was supported by the NIHR Biomedical Research Centre, Oxford.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Joint replacement ; Knee arthroplasty ; Hip arthroplasty ; Length of stay ; Costs
Publicado en:	BMJ open, Vol. 8, Issue 1 (January 2018) , article e019146, ISSN 2044-6055

DOI: 10.1136/bmjopen-2017-019146
PMID: 29374669

10 p, 1003.4 KB

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