Li Lambert T, Bokshan Steven L, Levins James G, Owens Brett D
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Orthop J Sports Med. 2020 Jun 22;8(6):2325967120926465. doi: 10.1177/2325967120926465. eCollection 2020 Jun.
Arthroscopic Bankart repair, open Bankart repair, and the Latarjet procedure are common treatments for anterior shoulder instability; however, little is known of costs by patient- and surgeon-specific factors. This study aimed to identify areas where cost reduction may be achieved.
Increased total charges will be associated with low-volume surgeons and surgical facilities, hospital-owned facilities, open surgical techniques, and patients with at least 1 comorbidity.
Economic and decision analysis; Level of evidence, 3.
The 2014 State Ambulatory Surgery and Services Databases from 6 states were utilized. There were 3 Current Procedural Terminology codes (23455, 23462, 29806) used to identify open Bankart repair, the Latarjet procedure, and arthroscopic Bankart repair, respectively. Patient demographic and surgical variables were evaluated on a univariate basis, and all significant factors were then included in the multiple linear regression to determine which factors had the largest effect on cost. Total charges billed for the encounter were used as a proxy for cost of surgery.
For open Bankart repair, arthroscopic Bankart repair, and the Latarjet procedure, longer operative times increased costs, and high-volume surgical facilities had decreased charges. For the arthroscopic Bankart group, additional factors that increased charges included postoperative hospital admission (US$11,516; < .001), patient residence in a ZIP code with a below-median income (US$2909; < .001), presence of a comorbidity (US$1982; < .001), male sex (US$1545; = .003), Hispanic race (US$2493; = .005), and use of regional anesthesia (US$1898; = .025). Additional cost drivers for the Latarjet procedure included postoperative hospital admission (US$7028; = .022) and older age (US$187/y; = .039).
Postoperative admission to the hospital was the largest cost driver for arthroscopic Bankart repair and the Latarjet procedure. Low-volume facilities were the largest cost driver for open Bankart repair. High-volume surgery centers had lower costs when compared with low-volume surgery centers. Regional anesthesia increased costs in the arthroscopic Bankart group. These findings may help to show where cost savings can be achieved, particularly considering increasing trends toward bundled health care payments.
关节镜下Bankart修复术、开放性Bankart修复术和Latarjet手术是治疗肩关节前向不稳的常用方法；然而，对于患者和外科医生特定因素导致的费用情况知之甚少。本研究旨在确定可能实现成本降低的领域。
总费用增加将与低手术量的外科医生、手术机构、医院所属机构、开放性手术技术以及至少有一种合并症的患者相关。
经济与决策分析；证据等级，3级。
使用来自6个州的2014年国家门诊手术和服务数据库。分别使用3个当前操作术语代码（23455、23462、29806）来识别开放性Bankart修复术、Latarjet手术和关节镜下Bankart修复术。对患者人口统计学和手术变量进行单因素评估，然后将所有显著因素纳入多元线性回归，以确定哪些因素对成本影响最大。本次就诊的总收费用作手术成本的替代指标。
对于开放性Bankart修复术、关节镜下Bankart修复术和Latarjet手术，手术时间延长会增加成本，高手术量的手术机构收费较低。对于关节镜下Bankart修复术组，增加收费的其他因素包括术后住院（11516美元；P<0.001）、患者居住在收入中位数以下邮政编码地区（2909美元；P<0.001）、存在合并症（1982美元；P<0.001）、男性（1545美元；P = 0.003）、西班牙裔种族（2493美元；P = 0.005）以及使用区域麻醉（1898美元；P = 0.025）。Latarjet手术的其他成本驱动因素包括术后住院（7028美元；P = 0.022）和年龄较大（每年187美元；P = 0.039）。
术后住院是关节镜下Bankart修复术和Latarjet手术最大的成本驱动因素。低手术量机构是开放性Bankart修复术最大的成本驱动因素。与低手术量手术中心相比，高手术量手术中心成本较低。区域麻醉增加了关节镜下Bankart修复术组的成本。这些发现可能有助于表明在哪些方面可以实现成本节约，特别是考虑到捆绑式医疗支付的增长趋势。
