The Economic Implications of a Multimodal Analgesic Regimen for Patients Undergoing Major Orthopedic Surgery A Comparative Study of Direct Costs

Background and Objectives: Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patient's undergoing lower extremity, joint replacement surgery, Methods: An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, Sex, Surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups, and a Subgroup analysis was performed based on ASA PS classification. Results: The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, $1999; 95% confidence interval, S584-$3231; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings. Conclusions: Use of a comprehensive, multimodal analgesic regimen (TJPA Clinical Pathway) in patients undergoing lower extremity joint replacement Surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Pail A) costs, with the greatest overall cost difference appearing among patients with signifiearn comorbidities (ASA PS III-IV patients).