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
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
Objectives: 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.
Design: cross-sectional study using routinely collected data.
Setting: 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.
Participants: study participants had a diagnosis of osteoarthritis or rheumatoid arthritis.
Interventions: primary TKR, primary THR, revision TKR and revision THR.
Primary outcome measures: length of stay and hospital reimbursement.
Results: 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.
Conclusions: 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.
Burn, E.
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Edwards, C.J.
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Murray, D.W.
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Silman, A.
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Cooper, Cyrus
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Arden, N.K.
43797db2-1a13-4ac5-9ac6-1dd3565cc4f2
Pinedo-Villanueva, R.
ec8ed49e-bf51-435b-a6ce-5a23da325b3c
Prieto-Alhambra, D
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Burn, E.
fa7e0782-cffc-479a-a41f-ba337a6554dc
Edwards, C.J.
d19255c4-eacd-4052-985b-dd522b06a8ab
Murray, D.W.
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Silman, A.
3111838f-93cd-4147-b89e-97f012240106
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, N.K.
43797db2-1a13-4ac5-9ac6-1dd3565cc4f2
Pinedo-Villanueva, R.
ec8ed49e-bf51-435b-a6ce-5a23da325b3c
Prieto-Alhambra, D
051113cd-2da1-4e0d-aa4b-d7b1fe63cd12
Burn, E., Edwards, C.J., Murray, D.W., Silman, A., Cooper, Cyrus, Arden, N.K., Pinedo-Villanueva, R. and Prieto-Alhambra, D
(2018)
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.
BMJ Open, 8 (1), [e019146].
(doi:10.1136/bmjopen-2017-019146).
Abstract
Objectives: 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.
Design: cross-sectional study using routinely collected data.
Setting: 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.
Participants: study participants had a diagnosis of osteoarthritis or rheumatoid arthritis.
Interventions: primary TKR, primary THR, revision TKR and revision THR.
Primary outcome measures: length of stay and hospital reimbursement.
Results: 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.
Conclusions: 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.
More information
Accepted/In Press date: 8 December 2017
e-pub ahead of print date: 27 January 2018
Identifiers
Local EPrints ID: 417503
URI: http://eprints.soton.ac.uk/id/eprint/417503
ISSN: 2044-6055
PURE UUID: 9afd9115-86a8-437f-a2ab-a2cb662fb3ac
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Date deposited: 01 Feb 2018 17:30
Last modified: 18 Mar 2024 02:46
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Contributors
Author:
E. Burn
Author:
C.J. Edwards
Author:
D.W. Murray
Author:
A. Silman
Author:
N.K. Arden
Author:
R. Pinedo-Villanueva
Author:
D Prieto-Alhambra
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