alexa The Economic Implications of a Multimodal Analgesic Reg
ISSN: 2155-6148

Journal of Anesthesia & Clinical Research
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Research Article

The Economic Implications of a Multimodal Analgesic Regimen Combined with Minimally Invasive Orthopedic Surgery: A Comparative Cost Study

Christopher M. Duncan1*, Kirsten Hall Long2, David O. Warner3, Mark W. Pagnano4 and James R. Hebl5

1Instructor of Anesthesiology, College of Medicine, Mayo Clinic

2Assistant Professor of Health Services Research College of Medicine, Mayo Clinic

3Professor of Anesthesiology, College of Medicine, Mayo Clinic

4Associate Professor of Orthopedic Surgery, College of Medicine, Mayo Clinic

5Associate Professor of Anesthesiology, College of Medicine, Mayo Clinic

*Corresponding Author:
Christopher M. Duncan MD
200 First Street, SW, Rochester, Minnesota 55905
Tel: (507) 266-8766
Fax: (507) 284-0120
E-mail: [email protected]

Received Date: July 23, 2010; Accepted Date: September 06, 2010; Published Date: September 06, 2010

Citation: Duncan CM, Long KH, Warner DO, Pagnano MW, Hebl JR (2010) The Economic Implications of a Multimodal Analgesic Regimen Combined with Minimally Invasive Orthopedic Surgery: A Comparative Cost Study. J Anesthe Clinic Res 1:101. doi: 10.4172/2155-6148.1000101

Copyright: © 2010 Duncan CM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Objectives: To evaluate the economic impact of the combined effect of minimally invasive surgery (MIS) and a multimodal analgesia regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing total knee arthorplasty (TKA) or total hip arthroplasty (THA).

Patients and Methods: A retrospective cohort, cost comparison study from the hospital prospective was performed on Mayo Clinic patients (n=37) undergoing MIS TKA or THA using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional surgical and anesthetic (non- TJRA) techniques. Hospital-based direct costs were collected for each patient and analyzed in standardized infl ationadjusted 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 upon ASA physical status classification.

Results: The estimated mean direct medical costs were signifi cantly reduced among MIS with TJRA patients compared to controls (cost difference: $4582; 95% CI $3299-$5864; P < .001). A signifi cant reduction was found in both the hospital-based (Medicare Part A) costs and the physician-based (Medicare Part B) costs.

Conclusions: The combined use of minimally invasive surgical (MIS) approaches and a multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement provides a signifi cant reduction in the estimated mean medical costs. A signifi cant reduction occurs in both the hospital based (Medicare Part A) and the physician based (Medicare Part B) costs. In subgroup analysis, the greatest difference was found among the patients with signifi cant comorbidities (ASA III-IV patients).

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