Journal of Advances in Applied Mathematics

Download PDF (570.9 KB) PP. 73 - 89 Pub. Date: January 1, 2016

DOI: 10.22606/jaam.2016.11007

• Blake James Huebner
  Department of Statistics, North Dakota State University, Fargo, ND, United States
• Rhonda C Magel^*
  Department of Statistics, North Dakota State University, Fargo, ND, United States

Drugs within three categories used in hip replacement surgery are compared based on their association with total hospital costs and length of stay. The drugs are also compared based on their associations with proportions of early readmissions. Multiple regression, logistic regression, chi- square tests, and multiple comparison techniques are used. The combination of warfarin and enoxaparin is associated with the highest cost and length of stay of the anticoagulants studied. There is no clear regional anesthesia drug used associated with the highest hospital cost and longest length of stay. Tranexamic acid is found to be associated with a smaller proportion of blood transfusions, a shorter length of stay, with no significant difference in cost found and no significant difference found in the proportion of early readmissions.

Anticoagulants, regional anesthesia drugs, antibribrinolytics, hospital cost, length of stay, proportions of early readmission, proportions of blood transfusions.

[1] Pfuntner, A, LM Wier, and C Steiner. Costs for Hospital Stays in the United States, 2010. HCUP Statistical Brief #146. Agency for Healthcare Research and Quality, Jan. 2013.

[2] Foran, Jared R.H., MD. "Total Hip Replacement." AAOS. N.p., Dec. 2011. Web. 05 May 2015.

[3] Wolford, Monica L., M.A., and Anita Bercovitz, M.P.H. "Hospitalization for Total Hip Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 12 Feb. 2015. Web. 05 May 2015.

[4] Txertsvadze, A., Grove, A., Freeman, K., Court, R., Johnson, S., Connock, M., Clarke, A., Sutcliffe, P. (2014). “Total Hip Replacement for the Treatment of End Stage Arthritis of the Hip: A Systematic Review and Meta-Analysis”, PLOS ONE, Web 8 July, 2014 DOI: 10.1371/journal.pone.0099804.

[5] Cowley, D. (1995). “Prostheses for Primary Total Hip Replacement: A Critical Appraisal of the Literature”, International Journal of Technology Assessment in Health Care, 11(4), 770-779.

[6] Kelly, E., Campbell, J., Murray, P. (2013). “Total hip replacement: patient satisfaction and early outcomes”, International Jouranl of Health Care Quality Assurance, 26(3), 262-268.

[7] Robold, L. and Bauer, P. (2005). “Yoga and Hip Replacement Surgery”, International Journal of Yoga Therapy, 15(1), 65-80.

[8] Syryla, W., Pogorzala, A., Rogala, P., Zurawski, P. (2009). “Functional Assessment after Total Hip Replacement, International Journal of Rehabilitation Research, 32(1), 59.

[9] Grant, S., St. John, W., Patterson, E. (2009). “Recovery from Total Hip Replacement Surgery: “It’s Not Just Physical” “. Qualitative Health Research, 19(11), 1612-1620.

[10] American Academy of Orthopaedic Surgeons. "Deep Vein Thrombosis." AAOS. N.p., Jan. 2009. Web. 05 May 2015.

[11] “Venous thromboprosphylaxis in general surgery ward admissions: strategies for improvement”, International Journal for Quality in Health Care, 2012, 24(6), 649-656.

[12] Wera, Glenn D., MD, Ryan M. Garcia, MD, and Victor M. Goldberg, MD. "Reducing Perioperative Bleeding with Antifibrinolytics." AAOS. N.p., Feb. 2013. Web. 05 May 2015.

[13] D. Ambrosia, R. D., P. R. Lipscomb, and E. J. McClain. "Prophylactic Anticoagulation in Total Hip Replacement." National Center for Biotechnology Information. U.S. National Library of Medicine, Apr. 1975. Web. 05 May 2015.

[14] Eriksson, Bengt I., Lars C. Borris, Richard J. Friedman, Sylvia Haas, Menno V. Huisman, Ajay K. Kakkar, and Tiemo J. Bandel. "Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty." New England Journal of Medicine 358.26 (2008): 2765-775. Web.

[15] Gomez-Outes, A., A. I. Terleira-Fernandez, M. L. Suarez-Gea, and E. Vargas-Castrillon. "Dabigatran, Rivaroxaban, or Apixaban versus Enoxaparin for Thromboprophylaxis after Total Hip or Knee Replacement: Systematic Review, Meta-analysis, and Indirect Treatment Comparisons." Bmj 344.Jun14 1 (2012): E3675. Web.

[16] Eisenberg, John M., Andrea Humphries, Ph.D, Amelia Williamson Smith, M.S., and Kim Farina, Ph.D. "Preventing Blood Clots After Hip or Knee Replacement Surgery or Surgery for a Broken Hip: A Review of the Research for Adults." AHRQ Effective Health Care Program. N.p., Mar. 2012. Web. 05 May 2015.

[17] Mauermann, William J., Ashley M. Shilling, and Zhiyi Zuo. "A Comparison of Neuraxial Block Versus General Anesthesia for Elective Total Hip Replacement: A Meta-Analysis." Anesthesia & Analgesia 103.4 (2006): 1018-025. Web.

[18] Rodgers, Anthony, and Natalie Walker. "Reduction of Postoperative Mortality and Morbidity with Epidural or Spinal Anaesthesia: Results from Overview of Randomised Trials." TheBjm. BMJ 2000;321:1493, 16 Dec. 2000. Web.

[19] Thorburn, J., J. R. Louden, and R. Vallance. "Spinal And General Anaesthesia In Total Hip Replacement: Frequency Of Deep Vein Thrombosis." BJA: British Journal of Anaesthesia 52.11 (1980): 1117-121. Web.

[20] NYSORA. "Spinal Anesthesia." NYSORA. The New York School of Regional Anesthesia, 10 Apr. 2013. Web. 03 May 2015.

[21] Zaric, Dusanka, and Nathan L. Pace. "Transient Neurologic Symptoms (TNS) following Spinal Anaesthesia with Lidocaine versus Other Local Anaesthetics." The Cochrane Library. John Wiley & Sons, Ltd., 15 Apr. 2008. Web. 03 May 2015.

[22] Hampl, Karl F., and Sidonie Heinzmann-Wiedmer. "Transient Neurologic Symptoms after Spinal Anesthesia : A Lower Incidence with Prilocaine and Bupivacaine than with Lidocaine." Anesthesiology. Lippincott-Raven Publishers, Mar. 1998. Web.

[23] Zaric, Dusanka, Christian Christiansen, Nathan L. Pace, and Yodying Punjasawadwong. "Transient Neurologic Symptoms After Spinal Anesthesia with Lidocaine Versus Other Local Anesthetics: A Systematic Review of Randomized, Controlled Trials." Anesthesia & Analgesia 100.6 (2005): 1811-816. Web.

[24] Bertini, L., S. Mancini, P. Di Benedetto, A. Ciaschi, O. Martini, S. Nava, and V. Tagariello. "Postoperative Analgesia by Combined Continuous Infusion and Patient-controlled Epidural Analgesia (PCEA) following Hip Replacement: Ropivacaine versus Bupivacaine." Acta Anaesthesiologica Scandinavica 45.6 (2001): 782-85. Web.

[25] Mcnamee, D. A., A. M. Mcclelland, S. Scott, K. R. Milligan, L. Westman, and U. Gustafsson. "Spinal Anaesthesia: Comparison of Plain Ropivacaine 5 Mg Ml-1 with Bupivacaine 5 Mg Ml-1 for Major Orthopaedic Surgery." British Journal of Anaesthesia 89.5 (2002): 702-06. Web.

[26] Wulf, H., and J. Biscoping. "Ropivacaine Epidural Anesthesia and Analgesia Versus General... : Anesthesia & Analgesia." LWW. International Anesthesia Research Society, July 1999. Web. 03 May 2015.

[27] Bower, Wendy F., Lawrence Jin, and Malcolm J. Underwood. "Peri-operative Blood Transfusion Increases Length of Hospital Stay and Number of Postoperative Complications in Non-cardiac Surgical Patients | HKMJ." Peri-operative Blood Transfusion Increases Length of Hospital Stay and Number of Postoperative Complications in Non-cardiac Surgical Patients | HKMJ. Hong Kong Med J, Apr. 2010. Web. 04 May 2015.

[28] Poeran, Jashvant, Rehana Rasul, and Suzuko Suzuki. "Tranexamic Acid Use and Postoperative Outcomes in Patients Undergoing Total Hip or Knee Arthroplasty in the United States: Retrospective Analysis of Effectiveness and Safety." TheBmj. BMJ, 17 July 2014. Web. 04 May 2015.

[29] Johansson, T., LG Pettersson, and B. Lisander. "Tranexamic Acid in Total Hip Arthroplasty Saves Blood and Money: A Randomized, Double-blind Study in 100 Patients." National Center for Biotechnology Information. U.S. National Library of Medicine, June 2005. Web. 04 May 2015.

[30] Gandhi, Rajiv, Heather Mk Evans, Safiyyah R. Mahomed, and Nizar N. Mahomed. "Tranexamic Acid and the Reduction of Blood Loss in Total Knee and Hip Arthroplasty: A Meta-analysis." BMC Research Notes 6.1 (2013): 184. Web.

[31] Irisson, E., Y. Hémon, V. Pauly, S. Parratte, J.-N. Argenson, and F. Kerbaul. "Tranexamic Acid Reduces Blood Loss and Financial Cost in Primary Total Hip and Knee Replacement Surgery." Orthopaedics & Traumatology: Surgery & Research 98.5 (2012): 477-83. Web.

[32] Panchmatia, Jaykar R., M.A., Soudeh Chegini, B.A., and Charlotte Lobban, M.B. "The Routine Use of Tranexamic Acid in Hip and Knee Replacements." National Center for Biotechnology Information. U.S. National Library of Medicine, 2012. Web. 05 May 2015.

[33] Abraham, Bovas, and Johannes Ledolter. Introduction to Regression Modeling. 1st ed. Belmont, CA: Thomson Brooks/Cole, 2006. Print.

[34] Kleinbaum, David, Lawrence Kupper, Keith Muller, and Azhar Nizam. Applied Regression Analysis and Multivariable Methods. 3rd ed. New York, NY: Duxbury Press, 1998. Print.

[35] Montgomery, Douglas C. Design and Analysis of Experiments. 8th ed. New York: John Wiley & Sons, 2013. Print.

[36] Pagano, Marcello, and Kimberlee Gauvreau. Principles of Biostatistics. 2nd ed. Pacific Grove, CA: Duxbury, 2000. Print.

[37] Daniel, Wayne W. Applied Nonparametric Statistics. Australia: Duxbury/Thomson Learning, 1990. Print.

[38] Hosmer, David W., and Stanley Lemeshow. Applied Logistic Regression. 2nd ed. New York: Wiley, 19.