Tufts University School of Medicine, Boston, Massachusetts, U.S.A.
Boston Sports and Shoulder Research Foundation, Waltham, Massachusetts, U.S.A.
Arthroscopy. 2024 May;40(5):1517-1526. doi: 10.1016/j.arthro.2023.10.050. Epub 2023 Nov 17.
To use time-driven, activity-based costing (TDABC) methodology to investigate drivers of cost variation and to elucidate preoperative and intraoperative factors associated with increased cost of outpatient arthroscopic hip labral repair.
A retrospective analysis of data from January 2020 to October 2021 was performed. Patients undergoing primary hip arthroscopy for labral repair in the outpatient setting were included. Indexed TDABC data from Avant-garde Health's analytics platform were used to represent cost-of-care breakdowns. Patients in the top decile of cost were defined as high cost, and cost category variance was determined as a percent increase between high and low cost. Analyses tested for associations between preoperative and perioperative factors with total cost. Surgical procedures performed concomitantly to labral repair were included in subanalyses.
Data from 151 patients were analyzed. Consumables made up 61% of total outpatient cost with surgical personnel costs (30%) being the second largest category. The average total cost was 19% higher for patients in the top decile of cost compared to the remainder of the cohort. Factors contributing to this difference were implants (36% higher), surgical personnel (20% higher), and operating room (OR) consumables (15% higher). Multivariate linear regression modeling indicated that OR time (Standardized β = 0.504; P < .001) and anchor quantity (standardized β = 0.443; P < .001) were significant predictors of increased cost. Femoroplasty (Unstandardized β = 15.274; P = .010), chondroplasty (Unstandardized β = 8.860; P = .009), excision of os acetabuli (unstandardized β = 13.619; P = .041), and trochanteric bursectomy (Unstandardized β = 21.176; P = .009) were also all independently associated with increasing operating time.
TDABC analysis showed that OR consumables and implants were the largest drivers of cost for the procedure. OR time was also shown to be a significant predictor of increased costs.
Level IV, economic analysis.
使用时间驱动、基于活动的成本核算（TDABC）方法来研究成本变化的驱动因素，并阐明与门诊关节镜髋关节盂唇修复成本增加相关的术前和术中因素。
对 2020 年 1 月至 2021 年 10 月的数据进行回顾性分析。纳入在门诊环境下接受盂唇修复的原发性髋关节镜检查的患者。使用 Avant-garde Health 的分析平台的索引 TDABC 数据来表示成本细分。将成本最高的十分位数患者定义为高成本，并将成本类别差异确定为高成本与低成本之间的百分比增加。分析测试了术前和围手术期因素与总费用之间的关联。同时进行的盂唇修复手术包括在亚分析中。
对 151 名患者的数据进行了分析。耗材占门诊总费用的 61%，手术人员费用（30%）为第二大类别。与队列其余部分相比，成本最高十分位数的患者的平均总成本高出 19%。导致这一差异的因素是植入物（高 36%）、手术人员（高 20%）和手术室（OR）耗材（高 15%）。多变量线性回归模型表明，OR 时间（标准化 β=0.504；P<.001）和锚定物数量（标准化 β=0.443；P<.001）是增加成本的显著预测因素。转子下成形术（Unstandardized β=15.274；P=.010）、软骨成形术（Unstandardized β=8.860；P=.009）、髋臼骨切除术（Unstandardized β=13.619；P=.041）和转子滑囊切除术（Unstandardized β=21.176；P=.009）也都与手术时间的增加独立相关。
TDABC 分析表明，OR 耗材和植入物是该手术成本的最大驱动因素。OR 时间也是增加成本的显著预测因素。
四级，经济分析。
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