What Effect Do Industry Payments Have on TJA Costs or Outcomes?

Do industry payments (consulting or clinical trial work) to total joint arthroplasty (TJA) surgeons or their institutions affect TJA costs or outcomes and, if so, how much?

A new study from Stanford University Medical Center compared data for more than 360,000 total joint arthroplasties with industry payment data and their results “Costs and Outcomes of Total Joint Arthroplasty in Medicare Beneficiaries Are Not Meaningfully Associated with Industry Payments,” was published in the November 22, 2023, edition of The Journal of Bone and Joint Surgery.

Total joint arthroplasty is one of the most commonly performed surgical procedures around the world. As the global population ages, the number of total joint arthroplasties is expected to continue to increase. At the same time, caregivers continuously seek to improve costs, efficiencies, and patient outcomes.

To what extent do industry payments affect TJA efficiency and patient outcome? To answer this question, the Stanford team collected data from a 20% sample of Medicare-insured patients undergoing primary elective total hip arthroplasty (THA) or primary elective total knee arthroplasty (TKA).

From the dataset, the team collected 130,872 THAs, performed by 7,539 surgeons and 230,856 were performed by 8,977 surgeons from 2013 to 2015.

Co-author Derek Amanatullah, M.D., Ph.D., associate professor of orthopedic surgery at Stanford University Medical Center, told OTW, “Higher total industry payments were associated with increased total costs and operating room costs of THA in Medicare patients, but the cost increase was minimal (between $0.20 and $0.50 increase for each $1,000 of payments).

Higher total industry payments were associated with a decreased length of stay after both THA and TKA.

Higher total industry payments were not associated with 30-day mortality after THA or TKA.

Higher total industry payments were associated with an increased 30-day readmission rate after THA. However, the magnitude of this relationship was very small; for each $1,000 increase in industry payments, the odds of 30-day readmission increased <0.1%.

Higher total industry payments were not associated with 30-day readmission after TKA.

While the team concluded that arthroplasty costs and outcomes were not meaningfully affected by industry relationships, Dr. Amanatullah did add, “We did not analyze the impact of the individual types of payments (particularly the specific influence of royalty payments as distinct from other forms of industry payments), and the accuracy of Open Payments data has been disputed because many deidentified payments are classified as research, but the outcome of that ‘research’ cannot be verified.”