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• W4386021836 abstract "BACKGROUND CONTEXT In the United States (US), demand for lumbar spinal surgery is increasing due to an aging population – with spinopelvic fixation becoming more common. Spinopelvic pathology (SPP) is present in approximately 16% of patients undergoing primary total hip arthroplasty (pTHA) and is associated with an increased risk of THA revision (rTHA) due to dislocation (estimated at 8% in patients with SPP). Adult spinal deformity surgeons should be aware of the increased risk of total hip dislocation with corrective spinal deformity surgery. Potential strategies exist to help minimize this risk, such as dual-mobility implants, anterior surgical approach, and technology-assistance (for example, digital 2D/3D presurgical planning, computer navigation, and robotic assistance). We hypothesized that reducing the risk of rTHA due to dislocation in patients with SPP results in substantial cumulative savings to the US payer. To our knowledge, the financial burden of rTHA due to dislocation among patients with SPP has not yet been established. PURPOSE To estimate (1) the target population size; (2) economic burden; and (3) 10-year projected savings to the payer of lowering the risk of rTHA due to dislocation in patients with SPP. STUDY DESIGN/SETTING Budget impact analysis. PATIENT SAMPLE Approximately 600,000 hospital inpatient pTHAs performed in the US during 2021. OUTCOME MEASURES (1) Revisions averted and (2) projected savings – over a 10-year period by reducing the risk of rTHA due to dislocation among patients with SPP. METHODS A budget impact analysis was undertaken using published literature; American Academy of Orthopaedic Surgeons American Joint Replacement Registry 2021 Annual Report; Centers for Medicare and Medicaid Services MEDPAR 2019 file; and National (Nationwide) Inpatient Sample (NIS) 2019. Expenditures were inflation-adjusted to 2021 US dollars using the Medical Care component of the Consumer Price Index. Sensitivity analyses were performed. RESULTS The target population size in calendar year 2021 was estimated at 5040 (range, 4830-6309) for Medicare (fee-for-service plus Medicare Advantage) and 8003 (range, 7669-10,018) for all-payer. The annual rTHA episode of care (through 90 days) expenditures for Medicare and all-payer were $185 million and $314 million, respectively. Using a 4.14% compound annual growth rate from NIS, the estimated number of applicable rTHA procedures that will be performed from 2022 to 2031 was 63,419 Medicare and 100,697 all-payer. With each 10% reduction in the relative risk of rTHA due to dislocation, Medicare and all-payer could save $233 million and $395 million, respectively, over a 10-year period. CONCLUSIONS For patients with SPP, a modest reduction in the risk of rTHA due to dislocation could achieve substantial cumulative savings to payers while improving healthcare quality. In the adult spinal deformity population, strategies to lower rTHA due to dislocation are warranted. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. In the United States (US), demand for lumbar spinal surgery is increasing due to an aging population – with spinopelvic fixation becoming more common. Spinopelvic pathology (SPP) is present in approximately 16% of patients undergoing primary total hip arthroplasty (pTHA) and is associated with an increased risk of THA revision (rTHA) due to dislocation (estimated at 8% in patients with SPP). Adult spinal deformity surgeons should be aware of the increased risk of total hip dislocation with corrective spinal deformity surgery. Potential strategies exist to help minimize this risk, such as dual-mobility implants, anterior surgical approach, and technology-assistance (for example, digital 2D/3D presurgical planning, computer navigation, and robotic assistance). We hypothesized that reducing the risk of rTHA due to dislocation in patients with SPP results in substantial cumulative savings to the US payer. To our knowledge, the financial burden of rTHA due to dislocation among patients with SPP has not yet been established. To estimate (1) the target population size; (2) economic burden; and (3) 10-year projected savings to the payer of lowering the risk of rTHA due to dislocation in patients with SPP. Budget impact analysis. Approximately 600,000 hospital inpatient pTHAs performed in the US during 2021. (1) Revisions averted and (2) projected savings – over a 10-year period by reducing the risk of rTHA due to dislocation among patients with SPP. A budget impact analysis was undertaken using published literature; American Academy of Orthopaedic Surgeons American Joint Replacement Registry 2021 Annual Report; Centers for Medicare and Medicaid Services MEDPAR 2019 file; and National (Nationwide) Inpatient Sample (NIS) 2019. Expenditures were inflation-adjusted to 2021 US dollars using the Medical Care component of the Consumer Price Index. Sensitivity analyses were performed. The target population size in calendar year 2021 was estimated at 5040 (range, 4830-6309) for Medicare (fee-for-service plus Medicare Advantage) and 8003 (range, 7669-10,018) for all-payer. The annual rTHA episode of care (through 90 days) expenditures for Medicare and all-payer were $185 million and $314 million, respectively. Using a 4.14% compound annual growth rate from NIS, the estimated number of applicable rTHA procedures that will be performed from 2022 to 2031 was 63,419 Medicare and 100,697 all-payer. With each 10% reduction in the relative risk of rTHA due to dislocation, Medicare and all-payer could save $233 million and $395 million, respectively, over a 10-year period. For patients with SPP, a modest reduction in the risk of rTHA due to dislocation could achieve substantial cumulative savings to payers while improving healthcare quality. In the adult spinal deformity population, strategies to lower rTHA due to dislocation are warranted." @default.
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• W4386021836 date "2023-09-01" @default.
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• W4386021836 title "29. Projected savings associated with lowering the risk of total hip arthroplasty revision due to dislocation among patients with spinopelvic pathology" @default.
• W4386021836 doi "https://doi.org/10.1016/j.spinee.2023.06.081" @default.
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