Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching.

BACKGROUND: Total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA. METHODS: All patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups. RESULTS: Except for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively. CONCLUSIONS: Our results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.

Study of influential factors of provincial health expenditure -analysis of panel data after the 2009 healthcare reform in China.

BACKGROUND: Total Healthcare Expenditure (THE) has increased substantially in all countries. Since the health system reform and health policy environment differ from each country, it is necessary to analyze the motivations of THE in a specific country. METHODS: The objective of this study was to analyze the influential factors of Provincial THE (PTHE) per capita in China by using spatiotemporal panel data across 31 provinces (including provinces, autonomous regions, and municipalities, all called provinces in here) from 2009 to 2016 at the provincial and annual level. Generalized Estimating Equation (GEE) was used to identify the influential factors of PTHE per capita. RESULTS: The number of beds per 10,000 population explained most of the variation of PTHE per capita. The results also showed that health expenditure in China reacts more to mortality compared with the Gross Domestic Product (GDP) per capita. But mortality and Out-Of-Pocket Payments (OOP) as a percentage of THE were associated with PTHE per capita negatively. The rate of infectious diseases and THE as a percentage of GDP had no statistical significance. And the Proportion of the Population Aged 65 and Over (POP65) impact PTHE per capita positively. But the coefficient was small. CONCLUSIONS: In response to these findings, we conclude that the impact of the increasing percentage of OOP in THE diminishes the PTHE. Furthermore, we find that both the "baseline" health level and health provision are positively correlated with PTHE, which outweighs the effect of GDP.

Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study.

OBJECTIVE: To evaluate the efficiency of county public hospitals in Shandong Province following China's new medical reform and compare the efficiency of hospitals with different bed sizes for improving efficiency. DESIGN AND SETTING: This was a cross-sectional study on the efficiency and size of 68 county public hospitals in China in 2017. OUTCOME MEASURES: Data envelopment analysis was used to calculate the efficiency scores of hospitals and to analyse the slack values of inefficient hospitals. The actual number of open beds, doctors, nurses and total expenditure were selected as inputs, and the total number of annual visits, discharges and total income were selected as outputs. The Kruskal-Wallis H test was employed to compare the efficiency of hospitals with different bed sizes. The χ2 test was used to compare the returns to scale (RTS) of hospitals with different bed sizes. RESULTS: Twenty (29.41%) hospitals were efficient. There were 27 hospitals with increasing returns to scale, 23 hospitals with constant returns to scale and 18 hospitals with decreasing returns to scale (DRS). The differences in technical efficiency (p=0.248, p>0.05) and pure technical efficiency (p=0.073, p>0.05) were not statistically significant. However, the differences in scale efficiency (p=0.047, p<0.05) and RTS (p<0.001) were statistically significant. Hospitals with DRS began to appear at 885 beds. All sample hospitals with more than 1100 beds were already saturated and some hospitals even had a negative scale effect. CONCLUSIONS: The government and hospital managers should strictly control the bed size in hospitals and make hospitals resume operating in the interests of public welfare. Interventions that rationally allocate health resources and improve the efficiency of medical workers are conducive to solving redundant inputs and insufficient outputs.

Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population.

BACKGROUND: Enhanced recovery after surgery (ERAS) programs have been proved effective for enhancing the clinical healing rate and reducing hospitalization cost in most countries of the world. It's a multi-model approach that designed to optimize perioperative pathway, attenuate the surgical stress response, and decrease postoperative complications. OBJECTIVE: The economic benefit from the application of ERAS to colorectal surgery has been demonstrated in China. However, such economic benefit of ERAS programs for hepatectomy hasn't been clarified yet. This study was carried out to explore the clinical efficacy and cost effectiveness of ERAS in Chinese Han population after hepatectomy. METHODS: ERAS program was implemented in our department for hepatectomy in December 2016. In total, 79 consecutive patients after hepatectomy were chosen as ERAS group (ERAS protocol) in coming half year while 121 consecutive patients after hepatectomy were chosen as Pre-ERAS group (traditional protocol) in past half year. The operation time, intraoperative blood loss, length of hospital stay (LOS), complication, readmission, and hospitalization cost of 2 groups were compared. RESULTS: The LOS of ERAS group was 5.81 ±â€Š1.79 days, significantly shorter than that of Pre-ERAS group (8.06 ±â€Š3.40 d) (P = .000). The operation time was 168.03 ±â€Š46.20 minutes for ERAS group and 175.41 ±â€Š64.64 minutes for Pre-ERAS group respectively (P = .417). The intraoperative blood loss was 166.58 ±â€Š194.13 mL (ERAS group) and 205.45 ±â€Š279.63 mL (Pre-ERAS group) (P = .293). It should be noted that the hospitalization cost of ERAS group was 51556.18 ±â€Š8926.05 Yuan (7835.05 ±â€Š1355.45 US dollars), significantly less than that of Pre-ERAS group 60554.66 ±â€Š15615.31 Yuan (9202.56 ±â€Š2371.24 US dollars) (P = .000). The application of ERAS effectively saved 8998.48 Yuan (1367.51 US dollars) for each patient. CONCLUSIONS: ERAS implementation for hepatectomy surgery is safe and feasible for Chinese Han population. It eventually enhanced the clinical healing rate. The benefits from such programs include a reduction of the LOS, complication, and readmission rates. So each patient has access to better medical service. It effectively relieved the financial burden of patients. The benefits from such programs include a reduction of the hospitalization cost, especially in medication cost. So each patient can afford the diseases.

[Clinical efficacy of low-dose oral theophylline for treating mild asthma].

OBJECTIVE: To observe the role of theophylline in relieving airway symptoms and inflammation in patients with mild asthma. METHODS: Fifty-six patients with mild asthma were randomly divided into treatment group (n=41) receiving oral theophylline at daily dose of 4 to 6 mg/kg for 16 weeks and control group (15 cases) without medication other than beta2 antagonist, which was administered when necessary in both groups. Peripheral blood T-lymphocyte subsets (CD3(+), CD4(+), and CD8(+)) and pulmonary function (PEF(am) and PD(20)) before and at 8 and 16 weeks during treatment were measured. RESULTS: Significant difference was observed in CD3+ and CD4(+) T-lymphocyte subsets after medication with theophylline (P<0.05) in the patients, and PEF(am) and PD(20) were also significantly different from those of the control group (P<0.05). Theophylline significantly improved the clinical symptom scores (P<0.05) and decreased the asthma attacks. CONCLUSION: Low-dose oral theophylline may significantly relieving airway inflammation in patients with mild asthma.