J Knee Surg 2019; 32(11): 1069-1074
DOI: 10.1055/s-0039-1688839
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical and Medical Costs for Fibromyalgia Patients Undergoing Total Knee Arthroplasty

Tara Moore
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
,
Nipun Sodhi
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
,
3   Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
,
Joseph Ehiorobo
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
,
Angad Kalsi
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
,
Hiba K. Anis
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Kristina Dushaj
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
,
Vivian Pappas
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
,
Rushabh M. Vakharia
4   Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
,
Matthew S. Hepinstall
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
,
Martin W. Roche
4   Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
,
Michael A. Mont
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
› Author Affiliations
Further Information

Publication History

15 December 2018

05 April 2019

Publication Date:
14 May 2019 (online)

Abstract

The potential added costs of managing fibromyalgia patients after total knee arthroplasty (TKA) have not been assessed. Therefore, the purpose of this study was to perform a cost analysis of fibromyalgia versus nonfibromyalgia patients who underwent TKA. Specifically, we evaluated the following episodes of care: (1) readmission rates, (2) total costs, (3) total reimbursements, and (4) net losses for surgical and medical complications. Patients who underwent TKAs between 2005 and 2014 from the Medicare Standard Analytical Files of the PearlDiver supercomputer were propensity score matched by patients with and without fibromyalgia in a 1:1 ratio based on age, sex, and the Charlson Comorbidity Index, yielding a total of 305,510 patients distributed equally between the cohorts for analysis. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated. Mean costs, total costs, and total reimbursements were assessed as along with total net losses, which were defined as total costs minus total reimbursements. Fibromyalgia patients had similar 90-day readmission rates compared with nonfibromyalgia patients (OR: 1.03; 95% CI: 1.00–1.06; p = 0.06) but incurred lower readmission costs (US$2,318,384,295 vs. US$2,534,482,404; p < 0.001). Although fibromyalgia patients had higher total reimbursements for medical complications ($27,758,057 vs. US$18,780,610; p < 0.001), the increased management costs (US$106,049,870 vs. US$66,080,469; p < 0.001) led to greater net losses (US$78,291,813 vs. US$47,299,859; p < 0.001). Similarly, although fibromyalgia patients had higher total reimbursements for surgical complications (US$94,192,334 vs. US$73,969,026; p < 0.001), the increased surgical costs (US$382,122,613 vs. US$306,359,910; p < 0.001) led to greater net losses (US$287,930,279 vs. US$232,390,884; p < 0.001). This study highlights some of the potential financial discrepancies of managing patients with fibromyalgia. Our findings suggest medical and surgical complication costs to be greater than reimbursement, resulting in overall net financial losses. These findings need to be considered in the light of health care reform and cost structuring.

 
  • References

  • 1 Imrie R. Fibromyalgia. InnovAiT Educ Inspir Gen Pract 2017; 10 (01) 45-50
  • 2 Rahman A, Underwood M, Carnes D. Fibromyalgia. BMJ 2014; 348 (05) g1224
  • 3 Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995; 38 (01) 19-28
  • 4 Vincent A, Lahr BD, Wolfe F. , et al. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis Care Res (Hoboken) 2013; 65 (05) 786-792
  • 5 Heidari F, Afshari M, Moosazadeh M. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int 2017; 37 (09) 1527-1539
  • 6 Jones GT, Atzeni F, Beasley M, Flüß E, Sarzi-Puttini P, Macfarlane GJ. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol 2015; 67 (02) 568-575
  • 7 Jay GW, Barkin RL. Fibromyalgia. Dis Mon 2015; 61 (03) 66-111
  • 8 Wolfe F, Walitt B. Culture, science and the changing nature of fibromyalgia. Nat Rev Rheumatol 2013; 9 (12) 751-755
  • 9 Wolfe F, Clauw DJ, Fitzcharles MA. , et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010; 62 (05) 600-610
  • 10 Ablin J, Neumann L, Buskila D. Pathogenesis of fibromyalgia - a review. Jt Bone Spine 2008; 75 (03) 273-279
  • 11 Bican O, Jacovides C, Pulido L, Saunders C, Parvizi J. Total knee arthroplasty in patients with fibromyalgia. J Knee Surg 2011; 24 (04) 265-271
  • 12 Brummett CM, Urquhart AG, Hassett AL. , et al. Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Arthritis Rheumatol 2015; 67 (05) 1386-1394
  • 13 Brummett CM, Janda AM, Schueller CM. , et al. Survey criteria for fibromyalgia independently predict increased postoperative opioid consumption after lower-extremity joint arthroplasty: a prospective, observational cohort study. Anesthesiology 2013; 119 (06) 1434-1443
  • 14 Namba RS, Singh A, Paxton EW, Inacio MCS. Patient factors associated with prolonged postoperative opioid use after total knee arthroplasty. J Arthroplasty 2018; 33 (08) 2449-2454
  • 15 D'Apuzzo MR, Cabanela ME, Trousdale RT, Sierra RJ. Primary total knee arthroplasty in patients with fibromyalgia. Orthopedics 2012; 35 (02) e175-e178
  • 16 Donnally III CJ, Vakharia RM, Rush III AJ. , et al. Fibromyalgia as a predictor of increased post-operative complications, readmission rates and hospital costs in patients undergoing posterior lumbar spine fusion. Spine 2019; 44 (04) E233-E238
  • 17 Wolfe F, Anderson J, Harkness D. , et al. A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis Rheum 1997; 40 (09) 1560-1570
  • 18 Berger A, Dukes E, Martin S, Edelsberg J, Oster G. Characteristics and healthcare costs of patients with fibromyalgia syndrome. Int J Clin Pract 2007; 61 (09) 1498-1508
  • 19 Thompson JM, Luedtke CA, Oh TH. , et al. Direct medical costs in patients with fibromyalgia: cost of illness and impact of a brief multidisciplinary treatment program. Am J Phys Med Rehabil 2011; 90 (01) 40-46
  • 20 Staffa SJ, Zurakowski D. Five steps to successfully implement and evaluate propensity score matching in clinical research studies. Anesth Analg 2018; 127 (04) 1066-1073
  • 21 Ofluoglu D, Gunduz OH, Kul-Panza E, Guven Z. Hypermobility in women with fibromyalgia syndrome. Clin Rheumatol 2006; 25 (03) 291-293
  • 22 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
  • 23 Moore T, Sodhi N, Kalsi A. , et al. A nationwide comparative analysis of medical complications in fibromyalgia patients following total knee arthroplasty. Ann Transl Med Publ Ahead Print 2019; 7 (04) 64
  • 24 Nelson SR, Polansky S, Vakharia RM. , et al. Fibromyalgia increases 90-day complications and cost following primary total hip arthroplasty. Ann Joint 2018; 3: 71
  • 25 Chandran A, Schaefer C, Ryan K, Baik R, McNett M, Zlateva G. The comparative economic burden of mild, moderate, and severe fibromyalgia: results from a retrospective chart review and cross-sectional survey of working-age U.S. adults. J Manag Care Pharm 2012; 18 (06) 415-426
  • 26 Rivera J, Rejas J, Esteve-Vives J, Vallejo MA. ; Groupo ICAF. Resource utilisation and health care costs in patients diagnosed with fibromyalgia in Spain. Clin Exp Rheumatol 2009; 27 (05) (Suppl. 56) S39-S45
  • 27 Vervoort VM, Vriezekolk JE, Olde Hartman TC. , et al. Cost of illness and illness perceptions in patients with fibromyalgia. Clin Exp Rheumatol 2016; 34 (02) (Suppl. 96) S74-S82
  • 28 Knight T, Schaefer C, Chandran A, Zlateva G, Winkelmann A, Perrot S. Health-resource use and costs associated with fibromyalgia in France, Germany, and the United States. Clinicoecon Outcomes Res 2013; 5: 171-180
  • 29 Haviland MG, Banta JE, Przekop P. Hospitalisation charges for fibromyalgia in the United States, 1999-2007. Clin Exp Rheumatol 2012; 30 (06) (Suppl. 74) 129-135