OBJECTIVES: The anterior approach (AA) for total hip arthroplasty (THA) is associated with more rapid recovery when compared to traditional approaches. This may result in economic benefits for patients and the healthcare system. The purpose of this study was to benchmark healthcare resource utilization and costs for patients with THA via AA relative to matched patients.

METHODS:

We queried Medicare claims data (2012-2014) to identify patients who received THA via an anterior approach from experienced surgeons, and matched these patients to a control cohort (all THA hip approaches/techniques). Direct and propensity-score matching were employed to maximize similarity between patients and hospitals in the two cohorts. Hospital length of stay (LOS), the proportion of patients discharged to home or home health, and post-acute claim payments during the 90-day episode were assessed. Generalized estimating equations were applied to control for imbalances between the cohorts and clustering of outcomes within hospitals.

RESULTS: A total of 1,794 patients (897 per group) were included after patient matching. Patients who received AA had significantly lower mean hospital LOS versus patients in the control group (2.06 ± 1.36 vs. 2.98 ± 1.58 days, p<0.0001). The adjusted proportion of patients discharged to home was nearly 20 percentage points higher in the AA cohort versus the control cohort (87.3% vs. 68.7%, p<0.0001). Post-acute claim payments for AA patients were nearly 50% lower than those for control patients ($4,139 vs. $7,465, P<0.0001).

CONCLUSIONS: AA patients had significantly lower in-hospital length of stay and post-acute care resource use when compared to control patients. Further research is warranted to evaluate the cost effectiveness of AA among surgeons of varying experience levels.