Cost analysis of bilateral primary total hip arthroplasty in a Spanish public hospital: One-stage versus two-stage approach.

Abstract

INTRODUCTION: Despite growing international evidence supporting the effectiveness, safety, and efficiency of simultaneous bilateral total hip arthroplasty (BTHA), its adoption remains limited in Spain, where the sequential approach (stg-BTHA) is still the most common practice. Assuming that the simultaneous option could offer benefits for both patients and the healthcare system in selected cases, this study aimed to compare the total and categorized healthcare costs between both modalities within a public secondary-level hospital in Spain. MATERIALS AND METHODS: A retrospective observational study was conducted including 14 patients who underwent bilateral THA performed by the same surgical team between March 2022 and March 2024. Seven patients underwent simultaneous BTHA and were matched with seven who underwent staged BTHA, based on age, sex, and ASA classification. Clinical, surgical, and economic variables were collected, and costs were categorized as pre-hospitalization, operating room, hospitalization, and postoperative follow-up. RESULTS: No significant differences were found in baseline characteristics between groups. Simultaneous BTHA showed a significantly shorter total operating room time (210±17min vs 240±21min; P=.028) and a shorter hospital stay (1.7±0.4 days vs 2.4±0.3 days; P=.04). The mean total cost was 33.5% lower in the simultaneous group (?8,139 vs ?10,868), with lower expenses across all categories. No patients required transfusion or experienced complications or readmissions. CONCLUSION: Simultaneous bilateral THA is more cost-efficient than the staged approach. It requires appropriate patient selection and a specialized multidisciplinary team, representing a safe and efficient option in the context of public healthcare.