Elsevier

The Knee

Volume 21, Issue 2, March 2014, Pages 491-496
The Knee

Quantifying the excess cost and resource utilisation for patients with complications associated with elective knee arthroscopy: A retrospective cohort study

https://doi.org/10.1016/j.knee.2013.11.009Get rights and content

Abstract

Background

Recent studies have demonstrated morbidity associated with elective knee arthroscopy. The objective of the current study was to quantify resource utilisation and costs associated with postoperative complications following an elective knee arthroscopy.

Methods

We undertook a retrospective, longitudinal cohort study using routinely collected hospital data from Victorian public hospitals during the period from 1 July 2000 to 30 June 2009. A generalised linear model was used to examine relative cost and length of stay for venous thromboembolism, joint complications and infections. Log-transformed multiple linear regression and retransformation were used to determine the excess cost after adjustment.

Results

We identified 166,770 episodes involving an elective knee arthroscopy. There were a total of 976(0.6%) complications, including 573 patients who had a venous thromboembolism (VTE) (0.3%), 227 patients with a joint complication (0.1%) and 141 patients with infections (0.1%). After adjustment, the excess 30-day cost per patient for venous thromboembolism was $USD + 3227 (95% CI: $3211–3244), for joint complications it was $USD + 2247 (95% CI: $2216–2280) and for infections it was $USD + 4364 (95% CI: $4331–4397).

Conclusion

This is the first study to quantify resource utilisation for complications associated with elective knee arthroscopy. With growing attention focused on improving patient outcomes and containing costs, understanding the nature and impact of complications on resource utilisation is important.

Introduction

Knee arthroscopy is a commonly performed, minimally invasive orthopaedic procedure. Recent population-based studies have demonstrated that there is a small, yet measurable, degree of associated morbidity. The most common complications reported in the literature are venous thromboembolic disease (VTE), infection and haemarthrosis [1].

Rates of symptomatic 90-day pulmonary embolism after knee arthroscopy have been estimated as ranging from 0.3 to 2.2 per 1000 patients [2], [3], compared to an incidence of 0.03 per 1000 within the general population [4]. The 90-day rates of symptomatic deep vein thrombosis (DVT) have been estimated as ranging from 1.2 to 3.6 per 1000 patients [5], [6], compared to 0.1 per 1000 within the general population [4]. In the UK, Jameson et al. identified the rate of any wound complication to be 0.22%, while others have estimated the risk of infection after arthroscopy as ranging from 0.08% to 0.4% [7], [8]. Haemarthrosis has been recognised as occurring in approximately one to two percent of knee arthroscopy cases [7], [9]. However, the majority of these do not require re-hospitalisation.

Although the incidence of complications in knee arthroscopy is low [10], the cost of post-operative complications associated with other types of surgeries is known to be high [11], [12], [13]. There is a high volume of knee arthroscopies performed each year [6], [14], [15] and likely growth in volume over the coming years as the population ages and the burden of musculoskeletal disease increases. As this growth may be correlated with an increasing number of post-operative complications, the objectives of the current study were to quantify resource utilisation of patients with post-operative complications and the cost of managing these patients from the perspective of the Australian health system. Accounting for the excess costs associated with post-operative complications will allow health systems, insurers and clinicians to make informed decisions about the allocation of resources for prevention initiatives.

Section snippets

Methods

This study was a retrospective, population-based analysis of hospital admissions data, linked to provide longitudinal information about patients'’ readmissions (first 30 postoperative days). These data include all elective adult (≥ 20 years) public and private hospital episodes in Victoria, Australia coded to orthopaedic or rheumatology diagnosis related groups from 1 July 2000 to 30 June 2009. We selected all patients with a procedure code indicating a knee arthroscopy to define our cohort (

Results

We identified 166,770 episodes involving an elective knee arthroscopy for 139,031 patients. This equates to 3.5 procedures per 1000 population aged over 20 years. The majority of patients were male (57.5%), had a same day admission (84.3%) and had no recorded Charlson or Elixhauser comorbidities (n = 89.0%). The largest proportion of the cohort was aged 40–59 years (46.9%) at the time of their procedure. Of those with comorbidities, hypertension (3.9%), diabetes (2.9%) and neoplasia (1.1%) were

Discussion

This is the first study to quantify the excess costs of post-operative complications after elective knee arthroscopy. It comprised the entire population of Victoria, including public and private hospital admissions, over a nine-year period. The majority of resource utilisation for managing complications occurred after separation from the episode involving the arthroscopy. Over half of the patients with readmissions (55%) were readmitted to different hospitals for treatment of their

Conclusion

This is the first study to quantify resource utilisation for complications associated with elective knee arthroscopy. All three postoperative complication types were associated with significantly increased hospitalisation costs, readmissions and length of stay up to 30 days after arthroscopy. With growing attention focused on improving patient outcomes and containing costs, understanding the nature and impact of complications on resource utilisation is important for the appropriate allocation of

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