Time Required for Planned and Unplanned Episodes of Care in Septic Two-Stage Revision Hip and Knee Arthroplasty

Published:January 10, 2022DOI:https://doi.org/10.1016/j.arth.2022.01.006



      Septic revision total hip (rTHA) and knee (rTKA) arthroplasty requires more effort but is reimbursed less than primary procedures per minute of intraoperative time. This study quantified planned and unplanned work performed by the surgical team for septic two-stage revision surgeries during the entire episode of care “reimbursement window” and compared that time to allowable reimbursement amounts.


      Between 10/2010-12/2020 all unilateral septic two-stage rTHA and rTKA procedures performed by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated over each episode of care, from surgery scheduling to 90-days postoperatively. Impromptu patient inquiries and treatments after discharge, but within the episode of care, involving the surgeon/surgeon team constituted unplanned work. Planned and unplanned work minutes were summed and divided by the number of patients reviewed to obtain average minutes of work per patient.


      Sixty-eight hips and 64 knees were included. For two-stage rTHA and rTKA the average time per patient for planned care was 1728 and 1716 minutes and for unplanned care was 339 and 237 minutes. Compared to the Centers for Medicare and Medicaid Services’ allowable reimbursement times, an additional 799 and 887 minutes of uncompensated time was required to care for two-stage rTHA and rTKA patients.


      Two-stage revision procedures are substantially more complex than primary procedures. Financially dis-incentivizing surgeons to care for these patients reduces access to care when high quality care is most needed. These findings support increasing the allowable times for two-stage septic revision cases.


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