Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Foot Ankle Int. 2024 Nov;45(11):1279-1291. doi: 10.1177/10711007241268225. Epub 2024 Sep 3.
Increasing overlap exists between surgeries performed by podiatrists and orthopaedic surgeons. Large-scale cost comparisons between the two are lacking despite the current climate of cost containment in health care. Using national Medicare data, we aimed to compare per-case Medicare payments between podiatrists and orthopaedic surgeons for ankle fracture fixation.
This retrospective cohort study included patients in an outpatient setting undergoing either unimalleolar, bimalleolar, or trimalleolar ankle fracture repair from the national Medicare Limited Data Set (2013-2019). Type of surgeon (podiatrist or orthopaedic surgeon) was determined using publicly available information. The primary outcome was total Medicare payments specific to the procedure, as a surrogate for cost. A subset analysis was also done to directly compare costs of orthopaedic surgeons to podiatric surgeons while excluding other fees (eg, hospital facility fees and surgery-related imaging payments). Additionally, patient demographics and hospital characteristics were compared to determine if any factors associated with costs may influence group differences. Univariable tests assessed significance of group differences.
Overall, 16 927 unimalleolar, 17 244 bimalleolar, and 11 717 trimalleolar fracture repairs were included; 86.7% and 13.3%, 92.4% and 7.6%, and 92.2% and 7.8% were performed by an orthopaedic surgeon or podiatrist, respectively. Median age (70-71 years) and median Charlson-Deyo Comorbidity Index (0) did not significantly differ between patients treated by either surgeon type. Median procedure-specific Medicare payments for all 3 categories of ankle fracture repairs (uni-, bi-, trimalleolar) were significantly lower for orthopaedic surgeons compared to podiatrists: $4156 vs $4300, $4205 vs $4379, and $4396 vs $4525, respectively (all < .001).
Our investigation using a national Medicare data set (2013-2019) found that the 3 types of ankle fractures (unimalleolar, bimalleolar, and trimalleolar) performed by orthopaedic surgeons in an outpatient setting were less expensive and that cost differences do not appear to be driven by patient characteristics. These results and further research into the causes of the cost differences may help improve the cost-effectiveness of ankle fracture surgery.
足病医生和矫形外科医生所进行的手术之间存在越来越多的重叠。尽管目前医疗保健领域存在成本控制的现状，但缺乏针对这两者的大规模成本比较。本研究利用全国医疗保险数据，旨在比较踝关节骨折固定术的足病医生和矫形外科医生的每例医疗保险支付情况。
这是一项回顾性队列研究，纳入了全国医疗保险有限数据集（2013-2019 年）中门诊接受单踝、双踝或三踝踝关节骨折修复的患者。使用公开信息确定手术医生类型（足病医生或矫形外科医生）。主要结果是特定于该手术的总医疗保险支付，作为成本的替代指标。还进行了亚组分析，直接比较矫形外科医生和足病医生的手术费用，同时排除其他费用（如医院设施费和与手术相关的影像学费用）。此外，比较患者人口统计学和医院特征，以确定是否有任何与成本相关的因素可能影响组间差异。单变量检验评估组间差异的显著性。
总体而言，纳入了 16927 例单踝、17244 例双踝和 11717 例三踝骨折修复术；分别有 86.7%和 13.3%、92.4%和 7.6%、92.2%和 7.8%由矫形外科医生或足病医生进行。接受任何类型手术的患者的中位年龄（70-71 岁）和中位 Charlson-Deyo 合并症指数（0）无显著差异。所有 3 类踝关节骨折修复术（单踝、双踝和三踝）的特定手术医疗保险支付中位数均显著低于矫形外科医生：4156 美元比 4300 美元，4205 美元比 4379 美元，4396 美元比 4525 美元（均 <.001）。
我们使用全国医疗保险数据集（2013-2019 年）进行的调查发现，在门诊环境中由矫形外科医生进行的 3 种踝关节骨折（单踝、双踝和三踝）的费用较低，而且费用差异似乎不是由患者特征驱动的。这些结果以及对成本差异原因的进一步研究可能有助于提高踝关节骨折手术的成本效益。
