Background/Purpose: Elective total knee arthroplasty (eTkA) is among the most commonly performed surgical procedures. The typical reasons for eTkA are pain and decreased quality of life (QoL) from osteoarthritis.  These patients can be at risk of various clinical complications, mobility impairment, muscle weakness, decreased ability to perform daily activities. The purpose of this study was to assess the patient characteristics, healthcare resource use, and costs among eTkA patients in large UK-based general practitioner and hospital databases.

Methods: The Clinical Practice Research Datalink (CPRD) linked to the Hospital Episode Statistics (HES) was used to estimate resource use in adult eTkA patients. Inclusion criteria: patients had no GP visits or inpatient stays with OPCS (4.6) procedure codes suggesting eTkA (W-40, 41, 42) in 7 days to 1 year prior to index date (hospital stay for eTkA) with at least 1 year of computerized data pre- and post-index hospitalization.  Elective TKA related medical costs (British Pound Sterling, 2012) were calculated by multiplying resource units by official publicly available costs from the NHS perspective.

Results: This study included 12,737 patients with mean age of 71 years, of whom approximately 26% were within 18–65 years of age. Pre-index, opioids (53%), NSAIDs (48%), and acetaminophen (34%) were the most common medications, followed by oral steroids (24%) and antidepressants (17%).   Nearly all patients had osteoarthritis (98.6%). Other common comorbidities were pulmonary disease (22.4%), cancer (14%), renal disease (13.9%), and osteoporosis (6.8%). The Charlson Comorbidity Index (mean score was 1.3. For the index hospitalization, average length of stay was 6.2 days and average costs (standard deviation [SD]) were £5,397 (2,459). After index hospitalization the majority of patients (97.5%) were discharged to their place of residence and 1.6% were discharged to another NHS hospital.  During their index hospitalization the majority of patients (98.0%) were treated by trauma and orthopedics; almost one-fourth (23.8%) were treated by general medicine. The mean (SD) total healthcare cost in the pre-index period was £2,507 (4168), driven mainly by inpatient costs that were £1,858. Average outpatient costs were £592 and pre-index pharmacy costs were £57.  During the post-index follow up, mean (SD) overall cost was £2068 (6519), with average inpatient costs of £1,526.

Conclusion:  This study described resource utilization, pain medications usage, and costs among patients undergoing eTkA in the UK. These estimates may provide a better understanding of the ubiquitous economic burden of this condition.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-analysis-of-healthcare-resource-utilization-among-patients-undergoing-total-knee-arthroplasty-in-the-united-kingdom/