HealthDay News – Primary elective unilateral total knee arthroplasties (TKA) performed at very-high volume hospitals are more cost-effective than lower volume hospitals, supporting regionalization of TKAs to these high-volume centers.

Undergoing TKA at very-high volume hospitals is associated with the lowest lifetime costs and greatest benefits, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 1 to 5 in Orlando, Fla.

Jayme C. Burket, PhD, from the Hospital for Special Surgery in New York City, and colleagues compared the cost-effectiveness of primary elective unilateral TKA over a patient’s lifetime among low, medium, high, and very-high volume hospitals using data from the New York Statewide Planning and Research Cooperative System from 1997 to 2014 for young (89,796 cases) and Medicare-age (111,492 cases) cohorts.

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The researchers found that the lowest lifetime costs and greatest benefits were seen for TKA surgery performed at very-high volume hospitals in the young cohort (costs: $45,684; $43,222; $41,244; and $29,899, for low, medium, high, and very-high volume hospitals, respectively; corresponding benefits: 17.07, 17.15, 17.19, and 17.22, quality-adjusted life-years). 

Similar results were seen in the Medicare cohort, although the cost savings were more modest. Total societal cost savings would be approximately $23 million annually if patients from low, medium, and high volume hospitals in New York State regionalized to very-high volume hospitals.

Summary and Clinical Applicability

Policies to incentivize a greater portion of procedures being performed by high-volume hospitals may increase the efficiency of resource utilization in health care delivery for primary elective TKA.

The authors state in their abstract that, “A total of 1.8 million patients will be eligible to regionalize from low and medium to high volume hospitals annually by the year 2030..Based on the results of this study, regionalization of these patients could translate into an annual societal cost-savings of over 4.8 billion dollars”.


Burket JC, Ghomrawi H, Dresner A, et al. The Cost-Effectiveness of Total Knee Arthroplasty at High Volume Hospitals. Paper 895 Presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons. Mar 04, 2016.