Primary total knee arthroplasties under the Brazilian Public Health Unic System (SUS) - Number of procedures, regional distribution, hospitalization costs, average length of hospital stay and mortality (2012-2021)
DOI:
https://doi.org/10.33448/rsd-v11i5.28548Keywords:
Arthroplasty, Replacement, Knee; Hospital Costs; Length of Stay; Mortality; Regional health planning.Abstract
The aim of this study was to describe the number and regional distribution of hospital admission authorization (AIH), hospitalization costs, average length of stay (LOS), and mortality rates related to primary total knee arthroplasty (TKA) procedures funded by the Brazilian Public Health Unic System (SUS) from 2012 to 2021. A cross-sectional descriptive study on the number and regional distribution of AIH, hospitalization costs, average LOS, and mortality rates related to primary TKA procedures funded by the SUS from 2012 to 2021 was done. As results, 65,602 AIH were released in the evaluated period; in 2020 and 2021 there was a sharp decrease of procedures, probably due to the COVID-19 pandemic. The total value spent in the evaluated period was of 271,297,010.60 BRL. The average LOS was of 4.15 days. The absolute number of deaths was of 103, with 0.16% of mortality rate. It was concluded that the number and regional distribution of AIH was of 37,370 (57%) to the Southeast; 18,907 (29%) to the South, 5,250 (8%) to the Northeast; 2,758 (4%) to the Midwest and 1,317 (2%) to the North, totaling 65,602 admissions, with a total expenditure of 271,297,010.60 BRL (156,252,541.60 BRL in Southeast, 77,150,946.31 BRL in South, 21,194,955.07 BRL in Northeast, 12,077,393.69 BRL in Midwest and 4,621,173.96 BRL in North). The average LOS (in days) was of 4.15 (4.15 in Southeast; 3.83 in South; 4.6 in Northeast; 4.81 in Midwest; and, 5.71 in North). The mortality rate was of 0.16% (Southeast=0,14%; South=0,1%; Northeast=0,16%; Midwest=0,17%; and North=0,14%).
References
Barahona, M., Infante, C. A., Palet, M. J., Barahona, M. A., Barrientos, C., & Martinez, A. (2021). Impact of the COVID-19 Outbreak on Orthopedic Surgery: A Nationwide Analysis of the First Pandemic Year. Cureus, 13(8), e17252. https://doi.org/10.7759/cureus.17252
Baxter, I., Hancock, G., Clark, M., Hampton, M., Fishlock, A., Widnall, J., Flowers, M., & Evans, O. (2020). Paediatric orthopaedics in lockdown: A study on the effect of the SARS-Cov-2 pandemic on acute paediatric orthopaedics and trauma. Bone & joint open, 1(7), 424–430. https://doi.org/10.1302/2633-1462.17.BJO-2020-0086.R1
Bozic, K. J., Ward, L., Vail, T. P., & Maze, M. (2014). Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clinical orthopaedics and related research, 472(1), 188–193. https://doi.org/10.1007/s11999-013-3034-3
Carducci, M. P., Gasbarro, G., Menendez, M. E., Mahendraraj, K. A., Mattingly, D. A., Talmo, C., & Jawa, A. (2020). Variation in the Cost of Care for Different Types of Joint Arthroplasty. The Journal of bone and joint surgery. American volume, 102(5), 404– 409. https://doi.org/10.2106/JBJS.19.00164
Chacur, E.P., Limongi, J.E., Diniz, F.L., Figueiredo, G.L.A., & Neiva, C.M. (2017). Obesidade e osteoartrite de joelhos: Perfil epidemiológico de usuários do sistema único de saúde. Encicl Biosf (Online), 14(25);1600-1612. https://doi.org/10.18677/EnciBio_2017A133
Chikuda, H., Yasunaga, H., Horiguchi, H., Takeshita, K., Sugita, S., Taketomi, S., Fushimi, K., & Tanaka, S. (2013). Impact of age and comorbidity burden on mortality and major complications in older adults undergoing orthopaedic surgery: an analysis using the Japanese diagnosis procedure combination database. BMC musculoskeletal disorders, 14, 173. https://doi.org/10.1186/1471-2474-14-173
Couto, R. A., Wiener, T. C., & Adams, W. P. (2021). Evaluating Postoperative Outcomes of Patients Undergoing Elective Procedures in an Ambulatory Surgery Center During the COVID-19 Pandemic. Aesthetic surgery journal, 41(2), 250–257. https://doi.org/10.1093/asj/sjaa180
D'Angelo, F., Monestier, L., De Falco, G., Mazzacane, M., & Stissi, P. (2020). Management of Traumatology Patients During the Coronavirus (COVID-19) Pandemic: Experience in a Hub Trauma Hospital in Northern Italy. Indian journal of orthopaedics, 54(Suppl 2), 397–402. https://doi.org/10.1007/s43465-020-00282-5
Faldini C. (2020). Reorganization of the Rizzoli Orthopaedic Institute during the COVID-19 outbreak. Musculoskeletal surgery, 104(3), 227–228. https://doi.org/10.1007/s12306-020-00688-2
Fang, C. J., Shaker, J. M., Stoker, G. E., Jawa, A., Mattingly, D. A., & Smith, E. L. (2021). Reference Pricing Reduces Total Knee Implant Costs. The Journal of arthroplasty, 36(4), 1220–1223. https://doi.org/10.1016/j.arth.2020.10.014
Featherall, J., Brigati, D. P., Arney, A. N., Faour, M., Bokar, D. V., Murray, T. G., Molloy, R. M., & Higuera Rueda, C. A. (2019). Effects of a Total Knee Arthroplasty Care Pathway on Cost, Quality, and Patient Experience: Toward Measuring the Triple Aim. The Journal of arthroplasty, 34(11), 2561–2568. https://doi.org/10.1016/j.arth.2019.06.011
Gonzi, G., Rooney, K., Gwyn, R., Roy, K., Horner, M., Boktor, J., Kumar, A., Jenkins, R., Lloyd, J., & Pullen, H. (2020). Trauma surgery at a designated COVID-19-free site during the pandemic: a safe model and a possible way to restart routine elective surgery. Bone & joint open, 1(6), 302–308. https://doi.org/10.1302/2046-3758.16.BJO-2020-0062.R1
Guedes, A. (2020). Proposta de protocolo de segurança hospitalar para abordagem de pacientes ortopédicos no contexto da pandemia COVID-19 (Trabalho de Conclusão de Curso - MBA Executivo em Administração: Gestão de Saúde). Fundação Getúlio Vargas, Rio de Janeiro, Brasil.
Heidari B. (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian journal of internal medicine, 2(2), 205–212.
Jain, A., Jain, P., & Aggarwal, S. (2020). SARS-CoV-2 Impact on Elective Orthopaedic Surgery: Implications for Post-Pandemic Recovery. The Journal of bone and joint surgery. American volume, 102(13), e68. https://doi.org/10.2106/JBJS.20.00602
Kamaraj, A., To, K., Seah, K. M., & Khan, W. S. (2020). Modelling the cost-effectiveness of total knee arthroplasty: A systematic review. Journal of orthopaedics, 22, 485–492. https://doi.org/10.1016/j.jor.2020.10.003
Lovald, S. T., Ong, K. L., Lau, E. C., Schmier, J. K., Bozic, K. J., & Kurtz, S. M. (2013). Mortality, cost, and health outcomes of total knee arthroplasty in Medicare patients. The Journal of arthroplasty, 28(3), 449–454. https://doi.org/10.1016/j.arth.2012.06.036
Lovald, S. T., Ong, K. L., Malkani, A. L., Lau, E. C., Schmier, J. K., Kurtz, S. M., & Manley, M. T. (2014). Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. The Journal of arthroplasty, 29(3), 510–515. https://doi.org/10.1016/j.arth.2013.07.020
Malanga, G., Niazi, F., Kidd, V. D., Lau, E., Kurtz, S. M., Ong, K. L., & Concoff, A. L. (2020). Knee Osteoarthritis Treatment Costs in the Medicare Patient Population. American health & drug benefits, 13(4), 144–153.
Mantilla, C. B., Horlocker, T. T., Schroeder, D. R., Berry, D. J., & Brown, D. L. (2002). Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology, 96(5), 1140–1146. https://doi.org/10.1097/00000542-200205000-00017
Meyers, S. J., Reuben, J. D., Cox, D. D., & Watson, M. (1996). Inpatient cost of primary total joint arthroplasty. The Journal of arthroplasty, 11(3), 281–285. https://doi.org/10.1016/s0883-5403(96)80079-9
Picardo, N. E., Walker, H., Vanat, Q., Nizar, B., Madura, T., & Jose, R. (2021). Service reconfiguration in the department of hand surgery during the UK COVID-19 lockdown: Birmingham experience. Postgraduate medical journal, 97(1150), 532–538. https://doi.org/10.1136/postgradmedj-2020-139280
Ruggieri, P., Trovarelli, G., Angelini, A., Pala, E., Berizzi, A., & Donato, D. (2020). COVID-19 strategy in organizing and planning orthopedic surgery in a major orthopedic referral center in an area of Italy severely affected by the pandemic: experience of the Department of Orthopedics, University of Padova. Journal of orthopaedic surgery and research, 15(1), 279. https://doi.org/10.1186/s13018-020- 01740-4
Sloan, M., Premkumar, A., & Sheth, N. P. (2018). Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. The Journal of bone and joint surgery. American volume, 100(17), 1455–1460. https://doi.org/10.2106/JBJS.17.01617
Soleimani, M., Barkhordari, S., Mardani, F., Shaarbafchizadeh, N., & Naghavi-Al Hosseini, F. (2020). Rationing access to total hip and total knee replacement in the Islamic Republic of Iran to reduce unnecessary costs: policy brief. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al Majallah al-sihhiyah li-sharq al-mutawassit, 26(11), 1396–1402. https://doi.org/10.26719/emhj.20.109
Stringer, H., Molloy, A., Craven, J., Moorehead, J., Santini, A., & Mason, L. (2021). The impact of COVID-19 on foot and ankle surgery in a major trauma centre. Foot (Edinburgh, Scotland), 46, 101772. https://doi.org/10.1016/j.foot.2020.101772
Xu, G. G., Sathappan, S. S., Jaipaul, J., Chan, S. P., & Lai, C. H. (2008). A review of clinical pathway data of 1,663 total knee arthroplasties in a tertiary institution in Singapore. Annals of the Academy of Medicine, Singapore, 37(11), 924–928.
Yao, D. H., Keswani, A., Shah, C. K., Sher, A., Koenig, K. M., & Moucha, C. S. (2017). Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis. The Journal of arthroplasty, 32(2), 375–380. https://doi.org/10.1016
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