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Increased Use of an Expensive, Elective Procedure: Total Hip Replacements in the 1980s
BERNARD S. FRIEDMAN, Anne Elixhauser. Medical Care, 1993-07-01
Topic: Risk, prevention and care in population studies
Between 1980 and 1987, the number of hospital discharges with total hip replacement (THR) increased by more than 90%, while total hospital discharges fell by more than 10%. Total hip replacement is one of the most costly hospital inpatient procedures, both per case and in total Medicare expenses. Explanations for the growth in use of THR may clarify some of the major forces driving national health care costs. This study assumes that treatment choices are made by (or for) each patient to maximize expected net benefits. Within this framework, the use of THR might have increased because of improved safety for the procedure, longer life expectancy and better control of many serious illnesses that led to increased demand for quality-enhancing procedures, and increased out-of-pocket cost for alternative treatments that are not covered well by insurance. These possible explanations imply changes in the characteristics of THR recipients over time. An upward shift was found in the age distribution of patients, more than simply because of an aging of the population. Sharply increased proportions of patients were also found with serious comorbidities such as cancer and dementia. The safety of the procedure seems to have improved, in terms of the death rate in the hospital. The results suggest that demands for expensive, elective procedures have been increasing for patients previously regarded as too old or impaired to benefit sufficiently. This process leads to continuing increases in real health care expenses even without the invention of new technologies.
Key findings
- The results suggest that demands for expensive, elective procedures have been increasing for patients previously regarded as too old or impaired to benefit sufficiently.
Why it matters
This study examined the growth in total hip replacement surgeries in the 1980s and found that more patients with serious conditions such as dementia were receiving the procedure. It does not test any treatment, cure, or prevention of Alzheimer's disease.
Study details
- Evidence strengthLow
How this study scored 35/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Medical Care) |
| Journal's citation record | 3 / 4 | Medical Care: journal h-index 273 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1993 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 38 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.1 citations a year over 35 year(s) since 1993 |
| Impact for its field and year | 4 / 6 | Cited 11.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Anne Elixhauser: h-index 50 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Agency for Healthcare Research and Quality: institution h-index 260 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 8326773) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 35 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
FRIEDMAN, B. S., & Elixhauser, A. (1993). Increased Use of an Expensive, Elective Procedure: Total Hip Replacements in the 1980s. Medical Care. https://doi.org/10.1097/00005650-199307000-00002
Vancouver
FRIEDMAN BS, Elixhauser A. Increased Use of an Expensive, Elective Procedure: Total Hip Replacements in the 1980s. Medical Care. 1993. doi:10.1097/00005650-199307000-00002. PMID: 8326773.
BibTeX
@article{friedman1993-8326773,
author = {FRIEDMAN, BERNARD S. and Elixhauser, Anne},
title = {{Increased Use of an Expensive, Elective Procedure: Total Hip Replacements in the 1980s}},
journal = {Medical Care},
year = {1993},
doi = {10.1097/00005650-199307000-00002},
pmid = {8326773},
url = {https://doi.org/10.1097/00005650-199307000-00002}
}
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