Baylor Jessica L, Kloc Austin, Delma Stephanie, Foster Brian K, Grandizio Louis C
Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
J Hand Surg Am. 2025 Jan;50(1):94.e1-94.e8. doi: 10.1016/j.jhsa.2023.04.019. Epub 2023 Jun 9.
This study aimed to quantify and assess perioperative costs in an integrated healthcare system for patients undergoing distal biceps tendon (DBT) repair with and without the use of postoperative bracing and formal physical (PT) or occupational (OT) therapy services. In addition, we aimed to define clinical outcomes after DBT repair using a brace-free, therapy-free protocol.
We retrospectively reviewed all cases of DBT repairs within our integrated system from 2015 to 2021. We performed a retrospective review of a series of DBT repairs utilizing the brace-free, therapy-free protocol. For patients with our integrated insurance plan, a cost analysis was conducted. Claims were subdivided to assess total charges, costs to the insurer, and patient costs. Three groups were created for comparisons of total costs: (1) patients who had both postoperative bracing and PT/OT, (2) patients who had either postoperative bracing or PT/OT, and (3) patients who had neither postoperative bracing nor PT/OT.
A total of 36 patients had our institutional insurance plan and were included in the cost analysis. For patients using both bracing and PT/OT, these services contributed 12% and 8% of the total perioperative costs, respectively. Implant costs accounted for 28% of the overall cost. Forty-four patients were included in the retrospective review with a mean follow-up of 17 months. The overall QuickDASH was 12; two cases resulted in unresolved neuropraxia, and there were no cases of re-rupture, infection, or reoperation.
Within an integrated healthcare system, postoperative bracing and PT/OT services increase the cost of care for DBT repair and account for 20% of the total perioperative charges in cases where bracing and therapy are used. Considering the results of prior investigations indicating that formal PT/OT and bracing offer no clinical advantages over immediate range of motion (ROM) and self-directed rehabilitation, upper-extremity surgeons should forego routine brace and PT/OT utilization after DBT repair.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在量化和评估在综合医疗保健系统中，接受或未接受术后支具固定以及正规物理治疗（PT）或职业治疗（OT）服务的肱二头肌远端肌腱（DBT）修复患者的围手术期费用。此外，我们旨在使用无支具、无治疗方案来定义DBT修复后的临床结果。
我们回顾性分析了2015年至2021年我们综合系统内所有DBT修复病例。我们对一系列采用无支具、无治疗方案的DBT修复进行了回顾性分析。对于参加我们综合保险计划的患者，进行了成本分析。将索赔细分为评估总费用、保险公司成本和患者成本。创建了三组以比较总成本：（1）接受术后支具固定和PT/OT的患者，（2）接受术后支具固定或PT/OT的患者，（3）既未接受术后支具固定也未接受PT/OT的患者。
共有36名患者参加了我们的机构保险计划并纳入成本分析。对于同时使用支具固定和PT/OT的患者，这些服务分别占围手术期总成本的12%和8%。植入物成本占总成本的28%。44名患者纳入回顾性分析，平均随访17个月。总体QuickDASH评分为12；2例出现未解决的神经失用症，无再断裂、感染或再次手术病例。
在综合医疗保健系统中，术后支具固定和PT/OT服务增加了DBT修复的护理成本，在使用支具固定和治疗的病例中占围手术期总费用的20%。考虑到先前调查结果表明，正规PT/OT和支具固定与立即进行活动范围（ROM）和自我指导康复相比并无临床优势，上肢外科医生应在DBT修复后放弃常规使用支具和PT/OT。
研究类型/证据水平：治疗性IV级。
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