Observational study of the profile of patients undergoing hip and knee arthroplasty in Chilean public hospitals funded through Diagnosis-Related Groups, from 2019 to 2023.

Abstract

Introduction: Hip and knee osteoarthritis are common causes of disability, with high social and economic impact. Total hip and knee arthroplasties are cost-effective interventions that significantly improve quality of life. However, timely access to these surgeries in the Chilean public healthcare system remains limited. Since 2019, the Diagnosis-Related Groups (DRG) system has enabled the financing of hospital surgical procedures by adjusting payments according to case complexity. The objective of our study was to describe the hospital volume, clinical profile of patients, and financing situation of arthroplasties performed between 2019 and 2023 in public hospitals operating under the Diagnosis-Related Groups system.

Methods: Observational, cross-sectional, and retrospective study. All procedures coded as primary total hip arthroplasty or total knee arthroplasty recorded in the Diagnosis-Related Groups database of the National Health Fund (FONASA) between January 2019 and September 2023 were analyzed. Clinical, demographic, geographic, and economic variables were extracted. Comorbidities were identified using the International Classification of Diseases, 10th revision (ICD-10).

Results: A total of 29 409 primary and 1993 revision arthroplasties were performed. Surgical volume decreased in 2020 and recovered progressively. Hospital productivity varied across regions. One-third of the total hip arthroplasties were performed in patients under 65 years old. The most frequent comorbidities were hypertension (43.4%) and diabetes (16.6%). The average reimbursement for revision surgeries was similar to that of primary procedures.

Conclusions: We identified regional inequities in access to total hip and knee replacements. We also found possible underreporting of comorbidities and underfunding of revisions, which highlights the need for specific adjustments to the Diagnosis-Related Groups system. In the future, it will be necessary to improve the quality of coding, expand financial coverage for patients excluded from the Explicit Health Guarantees, and incorporate technological adjustments that adequately reflect the costs of revisions, to move toward equitable and sustainable access to these surgeries.