Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, MN.
J Orthop Trauma. 2018 Jul;32(7):344-348. doi: 10.1097/BOT.0000000000001185.
To use surgical treatment of isolated ankle fractures as a model to compare time-driven activity-based costing (TDABC) and our institution's traditional cost accounting (TCA) method to measure true cost expenditure around a specific episode of care.
Level I trauma center ankle fractures treated between 2012 and 2016 were identified through a registry. Inclusion criteria were age greater than 18 years and same-day ankle fracture operation. Exclusion criteria were pilon fractures, vascular injuries, soft-tissue coverage, and external fixation. Time for each phase of care was determined through repeated observations. The TCA method at our institution uses all hospital costs and allocates them to surgeries using a relative value method.
A total of 35 patients met the inclusion/exclusion criteria, 18 were men and 17 were women. Age at time of surgery was 47 ± 15 years. Time from injury to surgery was 10 ± 4 days. Operative time was 86 ± 30 minutes, Post-anesthesia care unit (PACU) time was 87 ± 27 minutes, and secondary recovery time was 100 ± 56 minutes. Average cost was significantly lower for the TDABC method ($2792 ± 734) than the TCA method ($5782 ± 1348) (P < 0.001). There was no difference between methods for implant cost ($882 ± 507 for Traditional Accounting (TA) and $957 ± 651 for TDABC, P = 0.593). TCA produced a significantly greater cost (P < 0.01) in every other category.
As orthopaedics transitions to alternative payment models, accurate costing will become critical to maintaining a successful practice. TDABC may provide a better estimate of the cost of the resources necessary to treat a patient.
以踝关节骨折的手术治疗为例，比较时间驱动作业成本法（TDABC）和我院传统成本核算（TCA）方法，以衡量特定医疗护理期间的真实成本支出。
通过登记册确定 2012 年至 2016 年间在 I 级创伤中心治疗的踝关节骨折患者。纳入标准为年龄大于 18 岁且行踝关节骨折同期手术。排除标准为 Pilon 骨折、血管损伤、软组织覆盖和外固定。通过重复观察确定每一护理阶段的时间。我院的 TCA 方法使用所有医院成本，并使用相对价值法将其分配给手术。
共有 35 名患者符合纳入/排除标准，其中 18 名男性，17 名女性。手术时的年龄为 47 ± 15 岁。受伤至手术的时间为 10 ± 4 天。手术时间为 86 ± 30 分钟，麻醉后护理单元（PACU）时间为 87 ± 27 分钟，二次康复时间为 100 ± 56 分钟。TDABC 方法的平均成本明显低于 TCA 方法（$2792 ± 734 比 $5782 ± 1348）（P < 0.001）。两种方法的植入物成本无差异（传统会计（TA）$882 ± 507，TDABC $957 ± 651，P = 0.593）。TCA 在其他所有类别中产生的成本都显著更高（P < 0.01）。
随着骨科向替代支付模式转变，准确的成本核算对于维持成功的实践将变得至关重要。TDABC 可能提供更准确的估计，即治疗患者所需资源的成本。
