Pan Tommy, Gottshall Jacob, King Tonya S, Gallo Robert A
Orthopedic Surgery, Penn State College of Medicine, Hershey, USA.
Internal Medicine, Penn State College of Medicine, Hershey, USA.
Cureus. 2023 Feb 5;15(2):e34647. doi: 10.7759/cureus.34647. eCollection 2023 Feb.
Background The current study examines the financial charges associated with primary anterior cruciate ligament reconstruction (ACLR), specifically the contribution of graft choice, graft type, and concomitant meniscus surgery, in the outpatient hospital setting. Methods A retrospective financial billing review was performed on patients who underwent ACLR at a single academic medical center from January to December 2019. Age, BMI, insurance, length of operation, regional block, implants, meniscus surgery, graft type, and graft choice were extracted from hospital electronic patient records. Charges attributed with graft, anesthesia services, supplies, implants, surgeon fees, radiology charges, and total charges were collected. Total amount that insurance and patient paid were also obtained. Descriptive and quantitative statistics were performed. Results A total of 28 patients were studied (18 males, 10 females). The average age was 23.8 years. There were 20 concomitant meniscus surgeries. Six allografts and 22 autografts were used [eight bone-patellar tendon-bone (BPTB), eight hamstrings, six quadriceps]. The average and median total charge was $61,004 and $60,390, respectively (range: $31,403 to $97,914). The average insurance paid was $26,045 while out-of-pocket costs were $402. The average paid by private insurance was higher compared to government insurance ($31,111 vs. $11,066, p<0.001). Graft choice such as allograft vs. autograft (p=0.035) and meniscus surgery (p=0.048) were significant factors to the overall cost. Conclusions Graft choice, specifically the quadrupled hamstring autograft, and concomitant meniscal surgery are major contributors to variations in ACLR charges. Decreasing implant and graft costs and limiting surgical time can decrease charges associated with ACLR. We hope these findings can help guide surgeon financial decisions, by demonstrating the need to take into account the increased total charges and amount paid associated with specific grafts, meniscus surgery, and prolonged OR time.
背景 本研究探讨了门诊医院环境下初次前交叉韧带重建术（ACLR）的相关财务费用，特别是移植物选择、移植物类型和半月板同期手术的影响。方法 对2019年1月至12月在一家学术医疗中心接受ACLR的患者进行回顾性财务账单审查。从医院电子病历中提取年龄、体重指数、保险类型、手术时长、区域阻滞、植入物、半月板手术、移植物类型和移植物选择等信息。收集与移植物、麻醉服务、耗材、植入物、外科医生费用、放射学费用和总费用相关的收费情况。还获取了保险和患者支付的总金额。进行描述性和定量统计分析。结果 共研究了28例患者（18例男性，10例女性）。平均年龄为23.8岁。有20例半月板同期手术。使用了6例同种异体移植物和22例自体移植物[8例骨-髌腱-骨（BPTB）、8例腘绳肌、6例股四头肌]。平均总费用和中位数总费用分别为61,004美元和60,390美元（范围：31,403美元至97,914美元）。保险平均支付26,045美元，自付费用为402美元。与政府保险相比，私人保险的平均支付额更高（31,111美元对11,066美元，p<0.001）。移植物选择，如同种异体移植物与自体移植物（p=0.035）和半月板手术（p=0.048）是总体费用的重要影响因素。结论 移植物选择，特别是四倍体自体腘绳肌移植物，以及半月板同期手术是ACLR费用差异的主要因素。降低植入物和移植物成本以及缩短手术时间可以降低与ACLR相关的费用。我们希望这些发现能够通过证明需要考虑与特定移植物、半月板手术和延长手术时间相关的总费用增加和支付金额增加，来帮助指导外科医生的财务决策。
