# Comparison of inpatient charges and costs between revision and primary total elbow arthroplasty in the New York state

## TL;DR

This study compares the costs and outcomes of primary and revision elbow surgeries in New York State hospitals, finding that revision surgeries are more expensive and lead to longer hospital stays.

## Contribution

The study provides new evidence on the economic and clinical differences between primary and revision elbow surgeries, particularly in relation to hospital volume.

## Key findings

- Revision total elbow arthroplasty (rTEA) is associated with significantly higher inpatient charges and longer hospital stays compared to primary TEA (pTEA).
- Low-volume hospitals have higher total charges for primary TEA compared to medium- and high-volume hospitals.
- rTEA patients have higher 90-day readmission rates than pTEA patients.

## Abstract

The primary aim of this study is to evaluate differences in inpatient charges between primary (pTEA) and revision (rTEA) total elbow arthroplasty among Medicare and Medicaid patients. Our secondary aim is to assess whether these charges vary across hospitals with differing total elbow arthroplasty (TEA) procedural volumes. We hypothesize that rTEA would be more expensive than pTEA and that charges would be higher for low-volume hospitals.

The Statewide Planning and Research Cooperative System database was queried for all Medicare and Medicaid Services patients who underwent a pTEA or rTEA in New York State from 2010 to 2020. Hospitals were classified as high-volume (≥3 surgeries/year), medium-volume (between 2-3 surgeries/year), or low-volume (less than 2 surgeries/year). Facilities performing fewer than 1 surgery per year or with fewer than 4 years of TEA data were excluded. Total inpatient charges were collected and subsequently subdivided into ancillary and accommodation charges. Inpatient charges and readmission data were compared across the 2 procedures and volume groups.

During the study period, 1,303 patients underwent pTEA and 273 underwent rTEA. After adjusting for patient age, sex, race, and hospital volume, rTEA was independently associated with significantly higher accommodation, ancillary, and total inpatient charges (P < .001 for all). Additionally, rTEA patients had a higher likelihood of 90-day readmission (P = .005) and longer inpatient stays (P < .001) compared to pTEA patients. There were observable differences in total, accommodation, and ancillary charges across hospital volume groups for both pTEA and rTEA. Low-volume hospitals demonstrated the highest total charges for pTEA during the study period vs. high- and medium- volume hospitals (P < .001 for pTEA, P > .05 for rTEA).

rTEA is associated with longer inpatient stay, higher inpatient charges, and greater readmission rates compared to pTEA. Primary TEA in low-volume hospitals is associated with higher total charges compared to medium and high-volume hospitals. These findings provide valuable insights for hospital administrators and public health officials aiming to create effective strategies to manage costs and combat the growing burden of healthcare expenses in the United States.