Kazmers Nikolas H, Judson Christopher H, Presson Angela P, Xu Yizhe, Tyser Andrew R
Department of Orthopaedics, University of Utah, Salt Lake City, UT.
Department of Orthopaedics, University of Utah, Salt Lake City, UT.
J Hand Surg Am. 2018 Jul;43(7):606-614.e1. doi: 10.1016/j.jhsa.2018.04.015. Epub 2018 May 31.
Distal radius fracture open reduction and internal fixation (ORIF) represents a considerable cost burden to the health care system. We aimed to elucidate demographic-, injury-, and treatment-specific factors influencing surgical encounter costs for distal radius ORIF.
We retrospectively reviewed adult patients treated with isolated distal radius ORIF between November 2014 and October 2016 at a single tertiary academic medical center. Using our institution's information technology value tools-which allow for comprehensive payment and cost data collection and analysis on an item-level basis-we determined relative costs (RC) for each factor potentially influencing total direct costs (TDC) for distal radius ORIF using univariate and multivariable gamma regression analyses.
Of the included 108 patients, implants and facility utilization costs were responsible for 48.3% and 37.9% of TDC, respectively. Factors associated with increased TDC include plate manufacturer (RC 1.52 for the most vs least expensive manufacturer), number of screws (RC 1.03 per screw) and distal radius plates used (RC 1.67 per additional plate), surgery setting (RC 1.32 for main hospital vs ambulatory surgery center), treating service (RC 1.40 for trauma vs hand surgeons), and surgical time (RC 1.04 for every 10 min of additional surgical time). Open fracture was associated with increased costs (RC 1.55 vs closed fracture), whereas other estimates of fracture severity were nonsignificant. In the multivariable model controlling for injury-specific factors, variables including implant manufacturer, and number of distal radius plates and screws used, remained as significant drivers of TDC.
Substantial variations in surgical direct costs for distal radius ORIF exist, and implant choice is the predominant driver. Cost reductions may be expected through judicious use of additional plates and screws, if hospital systems use bargaining power to reduce implant costs, and by efficiently completing surgeries.
This study identifies modifiable factors that may lead to cost reduction for distal radius ORIF.
桡骨远端骨折切开复位内固定术（ORIF）给医疗保健系统带来了相当大的成本负担。我们旨在阐明影响桡骨远端ORIF手术费用的人口统计学、损伤和治疗相关因素。
我们回顾性分析了2014年11月至2016年10月期间在一家三级学术医疗中心接受单纯桡骨远端ORIF治疗的成年患者。使用我们机构的信息技术价值工具——该工具允许在项目层面进行全面的支付和成本数据收集与分析——我们通过单变量和多变量伽马回归分析确定了每个可能影响桡骨远端ORIF总直接成本（TDC）的因素的相对成本（RC）。
在纳入的108例患者中，植入物和设施使用成本分别占TDC的48.3%和37.9%。与TDC增加相关的因素包括钢板制造商（最昂贵与最便宜制造商相比，RC为1.52）、螺钉数量（每颗螺钉RC为1.03）和使用的桡骨远端钢板数量（每增加一块钢板RC为1.67）、手术地点（主医院与门诊手术中心相比，RC为1.32）、治疗科室（创伤外科与手外科相比，RC为1.40）以及手术时间（每增加10分钟手术时间RC为1.04）。开放性骨折与成本增加相关（与闭合性骨折相比，RC为1.55），而其他骨折严重程度评估无显著意义。在控制损伤相关因素的多变量模型中，包括植入物制造商、使用的桡骨远端钢板和螺钉数量等变量仍然是TDC的重要驱动因素。
桡骨远端ORIF手术直接成本存在显著差异，植入物选择是主要驱动因素。如果医院系统利用议价能力降低植入物成本，并高效完成手术，通过明智使用额外的钢板和螺钉有望降低成本。
本研究确定了可能导致桡骨远端ORIF成本降低的可改变因素。
