The University of Southampton
University of Southampton Institutional Repository

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
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.
2044-6055
Burn, E.
fa7e0782-cffc-479a-a41f-ba337a6554dc
Edwards, C.J.
d19255c4-eacd-4052-985b-dd522b06a8ab
Murray, D.W.
f581b8f8-3f6d-46c4-8c90-0642ae6048b9
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.
fa7e0782-cffc-479a-a41f-ba337a6554dc
Edwards, C.J.
d19255c4-eacd-4052-985b-dd522b06a8ab
Murray, D.W.
f581b8f8-3f6d-46c4-8c90-0642ae6048b9
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). (doi:10.1136/bmjopen-2017-019146).

Record type: Article

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.

Text e019146.full
Available under License Creative Commons Attribution.
Download (1MB)

More information

Accepted/In Press date: 8 December 2017
e-pub ahead of print date: 27 January 2018

Identifiers

Local EPrints ID: 417503
URI: https://eprints.soton.ac.uk/id/eprint/417503
ISSN: 2044-6055
PURE UUID: 9afd9115-86a8-437f-a2ab-a2cb662fb3ac
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 01 Feb 2018 17:30
Last modified: 06 Oct 2018 00:38

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×