Variation in inpatient hospital and physician payments among patients undergoing general versus orthopedic operations

Surgery. 2016 Dec;160(6):1657-1665. doi: 10.1016/j.surg.2016.07.013. Epub 2016 Aug 21.

Abstract

Background: Comparative data on surgeon payments for operative procedures are not well documented. We sought to assess variations in surgeon payments after common general and orthopedic operations using a nationally representative sample of privately insured patients.

Methods: A total of 486,506 patients who underwent a general (appendectomy, cholecystectomy, colectomy) or orthopedic (total knee replacement, total hip replacement) operation between 2010-2012 were identified from the Truven Health MarketScan database.

Results: Median age was 54 years (general operation, 44 years vs orthopedic operation, 58 years; P < .001). Patients had an average Charlson Comorbidity Index of 0 (interquartile range [IQR]: 0, 1). Median duration of stay was 3 days (IQR: 2, 4) (general operation, 3 days [IQR: 1, 5] vs orthopedic operation, 3 days [IQR: 2, 3]; P < .001). Total hospital payments averaged $18,209 (IQR: $11,751, $26,598) (general operation: $12,744 [IQR: $8,402, $19,896] vs orthopedic operation: $22,386 [IQR: $16,888, $30,100]; P < .001). Median surgeon reimbursement was $1,923 (IQR: $1,146, $2,676), with orthopedic surgeon payments being on average twice as high as general surgeon payments ($2,349 vs $1,191; P < .001). Median surgeon payment varied among both general (appendectomy: $903 vs cholecystectomy: $1,125 vs colectomy: $2,209; P < .001) and orthopedic operations (total knee replacement: $2,282 vs total hip replacement: $2,392; P < .001). The presence of a postoperative complication resulted in an increase in hospital payments by 25% and surgeon payments by 11%.

Conclusions: Hospital and surgeon payments following routine general and orthopedic operations vary greatly. Patients with comorbid conditions and those who experienced a postoperative complication resulted in higher overall payments. Though significant variability existed at the surgeon level, hospital payments were responsible for the highest source of variability.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Appendectomy / economics*
  • Arthroplasty, Replacement, Hip / economics*
  • Arthroplasty, Replacement, Knee / economics*
  • Cholecystectomy / economics*
  • Colectomy / economics*
  • Fees and Charges
  • Female
  • Health Expenditures / statistics & numerical data*
  • Hospitalization / economics
  • Humans
  • Male
  • Middle Aged
  • United States