Authors: Cozowicz C et al.
Anesthesiology, November 2025. DOI: 10.1097/ALN.0000000000005856
Summary
This large national cohort analysis evaluated economic impacts of major postoperative complications following total hip and knee arthroplasty (THA/TKA). Using the Premier Healthcare database from 2006–2022, the study included more than 2.36 million procedures. Although complications are relatively rare in joint arthroplasty, when they occur they markedly increase hospital costs, largely through prolonged length of stay (LOS).
Median cost without complications was approximately $16,800 for TKA and $17,250 for THA. Costs rose sharply with complications, particularly when multiple events occurred concurrently. Patients experiencing three or more complications had some of the highest expenditures, along with those experiencing sepsis or myocardial infarction. Multivariable modeling confirmed the greatest adjusted cost increases in patients with ≥3 complications (+136%), sepsis (+88%), and myocardial infarction (+73%). Meanwhile, common complications such as renal failure (+26%), pulmonary complications (+23%), and ICU admission (+61%) contributed heavily to overall financial burden due to their frequency.
The study highlights that while certain catastrophic events impose very high per-case costs, the majority of cumulative healthcare spending arises from more frequent complications and resource-intensive care such as ICU use and prolonged mechanical ventilation.
Key Points
• Study included over 2.36 million THA/TKA patients from 2006–2022.
• Median costs doubled or more with major complications, especially sepsis, MI, and clusters of ≥3 complications.
• Frequent complications (renal failure, pulmonary complications, ICU admission) were major drivers of overall financial burden.
• Prolonged LOS contributed substantially to excess costs.
• Targeting prevention of common complications and reducing resource-intensive care may yield the greatest cost savings in arthroplasty.
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