Abstract
Total hip arthroplasty (THA) is a common orthopedic procedure performed to replace damaged hip joints with prostheses. The demand for this procedure is expected to rise in the future. Enhanced Recovery After Surgery (ERAS) has been introduced as an evidence-based, multidisciplinary approach aimed at optimizing postoperative recovery and reducing hospital length of stay. This study aims to evaluate the costs and effectiveness, including hospital stay duration and surgical success rates, of THA using the ERAS protocol compared to conventional approaches. This cross-sectional study involved data collection from healthcare providers between January 2020 and May 2023. The analysis showed that both protocols achieved a 100% success rate in surgery, while a length of stay of ≤5 days was recorded in 88% of ERAS cases and 75% of conventional cases. The average costs were IDR 41,525,202 for the ERAS protocol and IDR 40,845,242 for the conventional protocol. Although no statistically significant differences were found in the direct medical costs or effectiveness between the two approaches, the primary cost differences were attributed to physician consultation and diagnostic examinations. This study was limited to cost and effectiveness analyses, without a comprehensive cost-effectiveness evaluation, such as calculating cost-effectiveness ratios. These findings provide initial insights into the economic implications of the ERAS protocol in Indonesian hospital settings.
References
Altman, A.D., Helpman, L., McGee, J., Samouëlian, V., Auclair, M.H., Brar, H. and Nelson, G.S., 2019. Enhanced recovery after surgery: Implementing a new standard of surgical care. CMAJ, https://doi.org/10.1503/cmaj.180635.
Antelo, M., Santias, F.R. and Calvo, A.M., 2015. Bed capacity and surgical waiting lists: A simulation analysis. European Journal of Government and Economics, 4(2), pp.118–133. https://doi.org/10.17979/ejge.2015.4.2.4310.
Badan Pusat Statistik, 2022. Statistik Penduduk Lanjut Usia 2022.
Bayliss, L.E., Culliford, D., Monk, A.P., Glyn-Jones, S., Prieto-Alhambra, D., Judge, A., Cooper, C., Carr, A.J., Arden, N.K., Beard, D.J. and Price, A.J., 2017. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. The Lancet, 389(10077), pp.1424–1430. https://doi.org/10.1016/S0140-6736(17)30059-4.
Fidanza, A., Schettini, I., Palozzi, G., Mitrousias, V., Logroscino, G., Romanini, E. and Calvisi, V., 2022. What Is the Inpatient Cost of Hip Replacement? A Time-Driven Activity Based Costing Pilot Study in an Italian Public Hospital. Journal of Clinical Medicine, 11(23). https://doi.org/10.3390/jcm11236928.
Götz, J., Maderbacher, G., Leiss, F., Zeman, F., Meyer, M., Reinhard, J., Grifka, J. and Greimel, F., 2024. Better early outcome with enhanced recovery total hip arthroplasty (ERAS-THA) versus conventional setup in randomized clinical trial (RCT). Archives of Orthopaedic and Trauma Surgery, 144(1), pp.439–450. https://doi.org/10.1007/s00402-023-05002-w.
Gunn, A.H., Schwartz, T.A., Arbeeva, L.S., Callahan, L.F., Golightly, Y., Goode, A., Hill, C.H., Huffman, K., Iversen, M.D., Pathak, A., Taylor, S.S. and Allen, K.D., 2017. Fear of Movement and Associated Factors Among Adults With Symptomatic Knee Osteoarthritis. Arthritis Care and Research, 69(12), pp.1826–1833. https://doi.org/10.1002/acr.23226.
Herrod, P.J.J., Adiamah, A., Boyd-Carson, H., Daliya, P., El-Sharkawy, A.M., Sarmah, P.B., Hossain, T., Couch, J., Sian, T.S., Wragg, A., Andrew, D.R., Parsons, S.L., Lobo, D.N., Johnson, B., Koh, A., Kushairi, A., Lewis-Lloyd, C., Roslan, F., Thompson, A., Wan, H., Kotecha, S., Sargen, K., Lund, J.N., Morton, A., Charles, E. and Singh, B., 2019. Winter cancellations of elective surgical procedures in the UK: A questionnaire survey of patients on the economic and psychological impact. BMJ Open, 9(9). https://doi.org/10.1136/bmjopen-2018-028753.
Ibrahim, M.S., Khan, M.A., Nizam, I. and Haddad, F.S., 2013. Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review. BMC Medicine, [online] 11, p.37. https://doi.org/https://doi.org/10.1186/1741-7015-11-37.
Judd, D.L., Thomas, A.C., Dayton, M.R. and Stevens-Lapsley, J.E., 2014. Strength and functional deficits in individuals with hip osteoarthritis compared to healthy, older adults. Disability and Rehabilitation, 36(4), pp.307–312. https://doi.org/10.3109/09638288.2013.790491.
Kaye, A., Urman, R., Cornett, E., Hart, B., Chami, A., Gayle, J. and Fox, C., 2019. Enhanced recovery pathways in orthopedic surgery. Journal of Anaesthesiology Clinical Pharmacology, https://doi.org/10.4103/joacp.JOACP_35_18.
Koh, W.X., Phelan, R., Hopman, W.M. and Engen, D., 2021. Cancellation of elective surgery: Rates, reasons and effect on patient satisfaction. Canadian Journal of Surgery, 64(2), pp.E155–E161. https://doi.org/10.1503/cjs.008119.
de Lima, F., Fernandes, D.A., Melo, G., Carlos, C.R., de S. Neves, F. and Neto, F.R., 2019. Effects of total hip arthroplasty for primary hip osteoarthritis on postural balance: A systematic review. Gait & Posture, 73, pp.52–64. https://doi.org/10.1016/J.GAITPOST.2019.07.124.
Maceroli, M., Nikkel, L.E., Mahmood, B., Ketz, J.P., Qiu, X., Ciminelli, J., Messing, S. and Elfar, J.C., 2016. Total Hip Arthroplasty for Femoral Neck Fractures: Improved Outcomes with Higher Hospital Volumes. Journal of Orthopaedic Trauma, 30(11), pp.597–604. https://doi.org/10.1097/BOT.0000000000000662.
Malik, A.T., Alexander, J.H., Li, D.D., Li, M., Khan, S.N. and Scharschmidt, T.J., 2020. What Are the Costs of Hip Osteoarthritis in the Year Prior to a Total Hip Arthroplasty? The Journal of Arthroplasty, 35(2), pp.313-317.e1. https://doi.org/10.1016/J.ARTH.2019.09.020.
Malviya, A., Martin, K., Harper, I., Muller, S.D., Emmerson, K.P., Partington, P.F. and Reed, M.R., 2011. Enhanced recovery program for hip and knee replacement reduces death rate: A study of 4,500 consecutive primary hip and knee replacements. Acta Orthopaedica, 82(5), pp.577–581. https://doi.org/10.3109/17453674.2011.618911.
Mayhew, D., Mendonca, V. and Murthy, B.V.S., 2019. A review of ASA physical status – historical perspectives and modern developments. Anaesthesia, https://doi.org/10.1111/anae.14569.
Murphy, L.B., Helmick, C.G., Schwartz, T.A., Renner, J.B., Tudor, G., Koch, G.G., Dragomir, A.D., Kalsbeek, W.D., Luta, G. and Jordan, J.M., 2010. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis and Cartilage, 18(11), pp.1372–1379. https://doi.org/10.1016/j.joca.2010.08.005.
Pamilo, K.J., Torkki, P., Peltola, M., Pesola, M., Remes, V. and Paloneva, J., 2018. Reduced length of uninterrupted institutional stay after implementing a fast-track protocol for primary total hip replacement: Register-based analysis of 4 hospitals and 3,193 replacements. Acta Orthopaedica, 89(1), pp.10–16. https://doi.org/10.1080/17453674.2017.1370845.
Phruetthiphat, O. art, Gao, Y., Anthony, C.A., Pugely, A.J., Warth, L.C. and Callaghan, J.J., 2016. Incidence of and Preoperative Risk Factors for Surgical Delay in Primary Total Hip Arthroplasty: Analysis From the American College of Surgeons National Surgical Quality Improvement Program. Journal of Arthroplasty, 31(11), pp.2432–2436. https://doi.org/10.1016/j.arth.2016.05.054.
Shalhoub, M., Anaya, M., Deek, S., Zaben, A.H., Abdalla, M.A., Jaber, M.M., Koni, A.A. and Zyoud, S.H., 2022. The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine. BMC Musculoskeletal Disorders, 23(1). https://doi.org/10.1186/s12891-022-05207-x.
Siviero, P., Veronese, N., Smith, T., Stubbs, B., Limongi, F., Zambon, S., Dennison, E.M., Edwards, M., Cooper, C., Timmermans, E.J., van Schoor, N.M., van der Pas, S., Schaap, L.A., Denkinger, M.D., Peter, R., Herbolsheimer, F., Otero, Á., Castell, M.V., Pedersen, N.L., Deeg, D.J.H. and Maggi, S., 2020. Association Between Osteoarthritis and Social Isolation: Data From the EPOSA Study. Journal of the American Geriatrics Society, 68(1), pp.87–95. https://doi.org/10.1111/jgs.16159.
Sommer, J.L., Jacobsohn, E. and El-Gabalawy, R., 2021. Impacts of elective surgical cancellations and postponements in Canada. Canadian Journal of Anesthesia, 68(3), pp.315–323. https://doi.org/10.1007/s12630-020-01824-z.
Uritani, D., Kasza, J., Campbell, P.K., Metcalf, B. and Egerton, T., 2020. The association between psychological characteristics and physical activity levels in people with knee osteoarthritis: A cross-sectional analysis. BMC Musculoskeletal Disorders, 21(1). https://doi.org/10.1186/s12891-020-03305-2.
Urman, R.D. and Stone, A.B., 2020. Quantifying Costs and Demonstrating Value of Enhanced Recovery After Surgery. American Society of Anesthesiologists, 84(3), pp.62–64.
Van den Berg, I., Buettner, S., van den Braak, R.R.J.C., Ultee, K.H.J., Lingsma, H.F., van Vugt, J.L.A. and Ijzermans, J.N.M., 2020. Low Socioeconomic Status Is Associated with Worse Outcomes After Curative Surgery for Colorectal Cancer: Results from a Large, Multicenter Study. Journal of Gastrointestinal Surgery, 24(11), pp.2628–2636. https://doi.org/10.1007/s11605-019-04435-2.
Vanni, F., Foglia, E., Pennestrì, F., Ferrario, L. and Banfi, G., 2020. Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment. BMC Health Services Research, [online] 20, pp.1–15. https://doi.org/https://doi.org/10.1186/s12913-020-05634-3.
Varacallo, M., Luo, T.D. and Johanson, N.A., 2022. Total Hip Arthroplasty Techniques. StatPearls Publishing.
Wainwright, T.W., Gill, M., McDonald, D.A., Middleton, R.G., Reed, M., Sahota, O., Yates, P. and Ljungqvist, O., 2020. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthopaedica, 91(1), pp.3–19. https://doi.org/10.1080/17453674.2019.1683790.
Wang, D., Liu, Z., Zhou, J., Yang, J., Chen, X., Chang, C., Liu, C., Li, K. and Hu, J., 2022. Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: A multicentre qualitative study. BMJ Open, 12(3). https://doi.org/10.1136/bmjopen-2021-053687.
Yoon, S.H. and Lee, H.J., 2024. Challenging issues of implementing enhanced recovery after surgery programs in South Korea. Anesthesia and Pain Medicine, https://doi.org/10.17085/apm.23096.
Zhu, S., Qian, W., Jiang, C., Ye, C. and Chen, X., 2017. Enhanced recovery after surgery for hip and knee arthroplasty: A systematic review and meta-analysis. Postgraduate Medical Journal, https://doi.org/10.1136/postgradmedj-2017-134991.
Bahasa Abstract
Total hip arthroplasty (THA) adalah prosedur ortopedi yang umum dilakukan untuk menggantikan sendi panggul yang rusak dengan prostesis. Permintaan terhadap prosedur ini diperkirakan akan meningkat di masa mendatang. Enhanced Recovery After Surgery (ERAS) diperkenalkan sebagai pendekatan multidisiplin berbasis bukti untuk mengoptimalkan pemulihan pascaoperasi dan mengurangi lama rawat inap. Penelitian ini bertujuan untuk mengevaluasi biaya dan efektivitas, yang mencakup lama rawat inap serta tingkat keberhasilan operasi, pada THA dengan protokol ERAS dibandingkan pendekatan konvensional. Penelitian ini menggunakan desain potong lintang dari perspektif penyedia layanan kesehatan, dengan data yang dikumpulkan antara Januari 2020 hingga Mei 2023. Analisis menunjukkan bahwa persentase keberhasilan operasi pada kedua protokol mencapai 100%, sementara lama rawat ≤5 hari tercatat sebesar 88% pada protokol ERAS dan 75% pada protokol konvensional. Rata-rata biaya tindakan masing-masing adalah Rp41.525.202 untuk protokol ERAS dan Rp40.845.242 untuk protokol konvensional. Meskipun tidak terdapat perbedaan yang signifikan secara statistik dalam biaya langsung medis maupun efektivitas kedua pendekatan, perbedaan biaya utama terjadi pada komponen konsultasi dokter dan pemeriksaan penunjang. Penelitian ini terbatas pada analisis biaya dan efektivitas, tanpa melakukan analisis efektivitas biaya secara menyeluruh, seperti perhitungan rasio biaya-efektivitas. Hasil ini memberikan gambaran awal tentang implikasi ekonomi dari protokol ERAS dalam konteks rumah sakit di Indonesia.
Recommended Citation
Lumbangaol, Hanna Elisabet and Nadjib, Mardiati
(2024)
"Evaluasi Ekonomi Total Hip Arthroplasty Protokol Enhance Recovery After Surgery Dibandingkan Konvensional di RSUP Fatmawati Jakarta,"
Jurnal Ekonomi Kesehatan Indonesia: Vol. 9:
No.
2, Article 2.
DOI: 10.7454/eki.v9i2.1127
Available at:
https://scholarhub.ui.ac.id/eki/vol9/iss2/2
