Ayoub Mark, Paul Bassett William, Seuffert Patricia, Matijakovich Douglas, O Hara Dorene A, Butler Mark S
Department of Orthopaedic Surgery, UCSF-Fresno, Fresno, CA.
Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ.
J Surg Educ. 2018 Sep-Oct;75(5):1333-1341. doi: 10.1016/j.jsurg.2018.02.015. Epub 2018 Mar 14.
Health care costs are increasing in medicine and in orthopedics. Device choice in orthopedic cases can impact the cost of the procedure and thus result in cost savings. This study aims to determine whether orthopedic attendings and residents accurately estimate device costs they are implanting in trauma cases and whether costs would influence their surgical device selection.
Using nationally published average cost data for 13 implants, a survey was distributed at 6 US academic centers. Respondents were asked to select the correct cost from cost ranges. They also answered yes/no questions about their choices regarding published research outcomes for specific fractures. Residents' answers were compared with faculty answers using t tests for each cost estimate question, and chi-square tests for yes/no questions and frequencies.
A total of 51 faculty members and 76 residents responded. Attending estimates were closer to the actual cost for most devices. The average total error in cost estimate for all 13 implants was $11,288.36 for residents (35.6% difference) and $10,208.33 for faculty members (32.2% difference). Significantly more faculty members estimated costs within 10% versus residents. When asked if the literature showed differences in outcome when using different implants to treat 4 common fractures, most answered these questions correctly. Further, 71.1% of residents said their choice of implant would change if costs affected physician reimbursements versus 58% for faculty members.
Our data indicate orthopedic physicians are not aware of true implant costs and nearly half of attendings would not consider cost as a factor in deciding between equivalent implants, even if this affected their reimbursement. Most notably, participants showed a poor ability to closely estimate the cost of more expensive implants (actual device cost greater than $2000). Our results suggest that medical cost containment should be stressed to the next generation of surgeons.
医疗保健成本在医学领域和骨科领域都在不断增加。骨科病例中的器械选择会影响手术成本，从而实现成本节约。本研究旨在确定骨科主治医师和住院医师是否能准确估计他们在创伤病例中植入器械的成本，以及成本是否会影响他们对手术器械的选择。
利用全国公布的13种植入物的平均成本数据，在美国6个学术中心开展了一项调查。受访者被要求从成本区间中选择正确的成本。他们还就针对特定骨折的已发表研究结果的选择回答是/否问题。对于每个成本估计问题，使用t检验比较住院医师和教员的答案；对于是/否问题和频率，使用卡方检验。
共有51名教员和76名住院医师做出回应。对于大多数器械，主治医师的估计更接近实际成本。13种植入物的成本估计总平均误差，住院医师为11,288.36美元（差异35.6%），教员为10,208.33美元（差异32.2%）。估计成本在10%以内的教员明显多于住院医师。当被问及文献是否表明使用不同植入物治疗4种常见骨折时结果存在差异时，大多数人正确回答了这些问题。此外，71.1%的住院医师表示，如果成本影响医生报销，他们对植入物的选择会改变，而教员为58%。
我们的数据表明，骨科医生并不了解植入物的真实成本，近一半的主治医师在选择等效植入物时不会将成本作为一个因素考虑，即使这会影响他们的报销。最值得注意的是，参与者对更昂贵植入物（实际器械成本超过2000美元）成本的精确估计能力较差。我们的结果表明，应向新一代外科医生强调医疗成本控制。
