Is the economic and social cost of one-stage bilateral hip resurfacing lower than two-stage procedures? Retrospective case-control study of 260 hips

Abstract

Background: Studies on the economic impact of medical practices and estimates of intra- and extra-hospital costs have an important role in controlling healthcare spending. But few studies of this nature have been done for bilateral surgery in a single operative session. This led us to carry out a health economics study to determine whether (1) bilateral hip resurfacing arthroplasty (HRA) performed in one stage instead of two stages will reduce the health care expenditures (costs of hospitalization, medical leave, rehabilitation), (2) it is equally safe for the patient. Hypothesis One-stage bilateral HRA is less costly for the health care system than two-stage bilateral resurfacing.

Methods: This was a single-center, single-surgeon retrospective cohort study comparing patients who underwent bilateral HRA in one stage (53 cases) or in two stages (77 cases). We determined the intra-hospital costs based on the French National Cost Scales and the extra-hospital costs (medical leave and rehabilitation), perioperative data (blood loss, operation time, duration of narcotic analgesic use, medical and surgical complications) and the outcomes with a mean follow-up of 4.8 years [1.7-10.1].

Results: The total costs for the one-stage group (€16,840.94±7042.7) were significantly less than those of the two-stage group (€19,335.0±7296.9) (p=0.0101). The two groups were comparable except for the one-stage group having more primary hip osteoarthritis indications (72% (38/53)) than the two-stage group (49% (38/77)) (p=0.0111). The main differences between groups was the cost and duration of hospitalization, with cost of €10,546.06±2049.47 and average length of stay (ALS) of 9.83±2.19 days in the one-stage group and €13,569.49±2186.30, ALS=15.04±3.15 days in the two-stage group (p<0.0001). There was no significant difference in the length of medical leave: 67.15±50.36 (0-180) days for the one-stage group and 97.89±108.39 (0-730) days for the two-stage group (p=0.1933).

Conclusion: Performing bilateral HRA during a single hospital stay results in lower health care expenditures than performing it during two separate hospital stays. Similar studies on other surgical procedures could help to promote the simultaneous nature of bilateral procedures and reset the current pricing, which is currently too low in the French health care system.

Level of evidence: III, Retrospective case-control study.

Keywords: Bilateral; Cost analysis; Hip resurfacing; One-stage versus two-stage.