Wetzel Robert J, Kempton Laurence B, Lee Edwin S, Zlowodzki Michael, McKinley Todd O, Virkus Walter W
Department of Orthopaedic Surgery and Sports Medicine, IU Health Methodist Hospital Orthopaedic Trauma Service, Indianapolis, IN.
J Orthop Trauma. 2016 Dec;30(12):e377-e383. doi: 10.1097/BOT.0000000000000687.
We hypothesized that negligible surgical material cost variation exists between traumatolgists for treatment of bimalleolar ankle and bicondylar tibial plateau fractures.
Retrospective medical record review.
Academic level 1 Trauma Center; 2-year period.
PATIENTS/PARTICIPANTS: Current Procedure Terminology codes for open treatment of bimalleolar ankle and bicondylar tibial plateau fractures identified patients. Patients who had operative treatment of other injuries under the same anesthetic session were excluded. Only definitive treatment procedures were analyzed.
We analyzed the intraoperative material costs of these procedures and compared them between surgeons. This analysis was done with a newly developed proprietary program designed for inventory and cost analysis.
Mean and median total case material costs were compared using one-way analysis of variance. Individual items that significantly increased costs were identified.
We identified 88 bimalleolar ankle and 46 bicondylar tibial plateau fractures treated by 6 surgeons. The mean intraoperative material cost per bimalleolar ankle fracture was $1099. The least expensive surgeon's mean case cost was $613, which was significantly less than the most expensive surgeon's $2243 (P = 0.009). The median cost range was $598-$784. The top quartile of cases resulted in 57% of overall material cost for ankle fractures. The mean intraoperative material cost per bicondylar tibial plateau fracture was $3219 (range $1839-$4088, P = 0.064). The range of median costs ($1826-$3989) was significantly wider than for ankle fractures. Bone void fillers, locking plates, adjunctive external fixators, mini-fragment locking plates, cannulated screws, single-use taps, guidewires, and drill bits all substantially increased costs.
This study demonstrated variation in intraoperative material cost between 6 traumatologists resulting from practice variations despite similar specialty training. The cost differences resulting from practice variation reveal potential savings through increased standardization of surgical care for similar injuries. We identified high-cost items, which could lead to cost savings if used only when they will have clinical benefit.
我们假设，在治疗双踝骨折和双髁胫骨平台骨折时，创伤骨科医生之间手术材料成本差异可忽略不计。
回顾性病历审查。
一级学术创伤中心；为期2年。
患者/参与者：通过当前手术操作术语编码确定开放性治疗双踝骨折和双髁胫骨平台骨折的患者。排除在同一麻醉期接受其他损伤手术治疗的患者。仅分析确定性治疗程序。
我们分析了这些手术的术中材料成本，并在外科医生之间进行比较。该分析使用新开发的用于库存和成本分析的专有程序进行。
使用单因素方差分析比较平均和中位数总病例材料成本。确定显著增加成本的单项物品。
我们确定了由6名外科医生治疗的88例双踝骨折和46例双髁胫骨平台骨折。每例双踝骨折的平均术中材料成本为1099美元。成本最低的外科医生的平均病例成本为613美元，显著低于成本最高的外科医生的2243美元（P = 0.009）。中位数成本范围为598 - 784美元。病例的前四分位数导致踝关节骨折的总体材料成本占57%。每例双髁胫骨平台骨折的平均术中材料成本为3219美元（范围1839 - 4088美元，P = 0.064）。中位数成本范围（1826 - 3989美元）比踝关节骨折的范围显著更宽。骨缺损填充材料、锁定钢板、辅助外固定器、微型锁定钢板、空心螺钉、一次性丝锥、导丝和钻头均大幅增加成本。
本研究表明，尽管专业培训相似，但由于实践差异，6名创伤骨科医生之间术中材料成本存在差异。实践差异导致的成本差异表明，通过提高类似损伤手术治疗的标准化程度可能实现成本节约。我们确定了高成本项目，如果仅在具有临床益处时使用，可能会节省成本。
