Quantifying and Predicting Surgeon Work Input in Primary vs Revision Total Hip Arthroplasty

Mark J Isaacson, Kevin J Bunn, Philip C Noble, Sabir K Ismaily, Stephen J Incavo

Primary total hip arthroplasties (THAs) performed annually are projected to increase 174% by 2030, causing a parallel increase for revision THA. Increased surgical effort and readmission rates associated with revision THA may discourage surgeons from performing them. Although revision THA Medicare reimbursement is greater, it may be disproportionate to time and effort. We examined work input between primary and revision THA, assessing predictive factors. We also compared surgeon work input to current reimbursement. A total of 156 patients were identified, 80 primary and 76 revision THA. Demographic, clinical, and radiographic data were collected. Radiographic data were collected from the most recent preoperative radiographs taken before primary or revision THA. Multiple linear and logistic regression models were used to identify patient factors contributing to select outcome variables by a stepwise method, with a probability value for entry (P = .05) and removal (P = .10). Residual analysis was performed, confirming validity of these models. Average age, body mass index, and percentage of female patients were similar between cohorts. There was no statistically significant difference between the demographic variables, although data revealed patient variables contributing to statistically significant increases in surgical time, length of stay, blood loss, and complications with revision THA. Despite a 66% increase in "percent effort" and 3-fold higher readmission rate, revision THA requires at least a 2-fold increase because of nonquantifiable factors. Revision THA demonstrates a substantial increase in work effort not commensurate with current Medicare reimbursement, which may force surgeons to limit or eliminate revision arthroplasties performed reducing access to patient care.