High-volume revision surgeons are more cost-effective following revision total hip and knee arthroplasty.

Abstract

Background: With the increased rates of revision total hip (rTHA) and total knee arthroplasty (rTKA), the financial burden of these procedures is at risk of straining the healthcare system. Our study sought to create a model to evaluate the cost-effectiveness of rTKA and rTHA performed by high-volume (HV) and low-volume (LV) surgeons.

Methods: The database of rTKA and rTHA from April 2018 to March 2021 at our academic institution was retrospectively reviewed. Surgeons above the 90^th percentile in annual volume were classified as HV surgeons and the remainder were classified as LV surgeons. Previously published cost estimates were utilised for operative time, hospital length of stay (LOS), discharge disposition, 90-day readmission, and 1-year re-revision.

Results: A total of 442 rTKA were performed by 30 surgeons and 420 rTHA were performed by 32 surgeons. 3 surgeons were HV in each group with HV surgeons performing 213 (48.2%) rTKA and 215 (51.2%) rTHA in the study period. LV surgeons had longer operative times for both rTKA (167.1 vs. 145.8 minutes; p < 0.001) and rTHA (172.5 vs. 151.2 minutes; p < 0.001). Both groups had equivalent discharge disposition, 90-day readmission, and 1-year re-revision. HV surgeons had lower estimated mean costs for rTHA ($22,027.81 vs. $24,617.39) and rTKA ($20,343.23 vs. $18,554.67).

Conclusions: HV surgeons have a lower estimated mean cost for both rTHA and rTKA. Healthcare systems may benefit from having rTHA and rTKA procedures performed by HV surgeons who are able to perform these revision procedures for a lower cost without negatively impacting patient outcomes.