Examining Outcomes After Total Hip Arthroplasty Performed at Public or Private Hospitals

According to a retrospective analysis, federal payment models to lower costs and improve the quality of patient care for total hip arthroplasties (THAs) have affected public and private hospital systems differently. The study was conducted by Wayne Wilkie, DO, MHSA, and colleagues from the Clinical Research Division at the Rubin Institute for Advanced Orthopedics in Baltimore.

The researchers collected data on 303,633 patients who underwent THA between during the same period in 2016 and 2017 and were included in the National Readmission Database.

Patients were then stratified into three groups according to the type of hospital where they underwent THA:

• government non-federal (n = 24,606)
• private for-profit (n = 39,346)
• private nonprofit (n = 239,681)

Patient age, sex, adjusted Charlson comorbidity index, body mass index, primary payer, and median household income were also collected.

Looking at the hospital characteristics, the researchers reported that 49.1% of the for-profit systems identified were located in urban areas and were nonteaching organizations. However, only 21.8% and 23.4% of government institutions and nonprofit institutions, respectively, could be considered urban, nonteaching organizations.

Patient demographics were similar among the different institutional systems, and Medicare was the most common type of primary insurance type (56% across all institutions), followed by private insurance (36% across all institutions).

Costs of THAs differed significantly among institutions:

• $21,675 for government institutions
• $16,887 for for-profit institutions
• $19,148 for nonprofit institutions

Patients treated at government institutions had longer in-hospital length of stay (3.19 days) compared with those who underwent THA at for-profit (3.04 days) and nonprofit hospitals (2.60 days).

Based on these findings, the authors noted a few common trends: Government hospitals catered to the underserved, for-profit institutions maximized cost efficiency, and nonprofit hospitals had the lowest complication rates.