与胫距关节融合相关的手术费用研究。

Study of Surgical Costs Associated With Tibiotalar Fusion.

作者信息

Wagers Kade, Zhang Chong, Presson Angela, Nixon Devon

机构信息

Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA.

Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.

出版信息

Foot Ankle Orthop. 2025 May 6;10(2):24730114251332941. doi: 10.1177/24730114251332941. eCollection 2025 Apr.

DOI:10.1177/24730114251332941

PMID:40342562

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12059449/

Abstract

BACKGROUND

There is growing focus on surgical costs related to common orthopaedic procedures. In this investigation, we studied surgical costs associated with tibiotalar arthrodesis.

METHODS

Patients were retrospectively identified who had undergone primary fusion of the tibiotalar joint based on () codes from 2014 to 2020. Using the Value Driven Outcome (VDO) tool, we conducted an evaluation of both total direct costs and facility-related expenses. The VDO tool encompasses a comprehensive item-level database capable of capturing detailed cost information, which is subsequently presented as relative mean data. Adjustments were made to cost variables to reflect 2022 US dollars, and comparative multivariable analysis of costs in relation to treatment groups adjusting for demographic variables was performed using generalized linear models to yield cost ratios along with 95% CIs.

RESULTS

Our cohort consisted of 262 patients who underwent primary ankle fusion procedures done by one of 4 fellowship-trained orthopaedic foot and ankle surgeons. There were no differences in demographic data or total operating room (OR) time based on surgical construct (screws-alone n = 228 vs anterior plate-screws n = 34). Total direct costs for anterior plate-screw constructs were 78% higher than screws alone (ratio in cost = 1.78, 95% CI 1.55-2.08, < .001), adjusting for other variables. For all fusion constructs, every 1-hour increase in total OR time increased total direct costs by 29% (ratio in cost = 1.29, 95% CI 1.18-1.40, < .001).

CONCLUSION

Enhancing cost-effectiveness of orthopaedic care remains an important objective. Our investigation found that anterior plate-screw constructs for tibiotalar arthrodesis have notably higher total costs compared with screw-only constructs. Many variables are considered when selecting surgical constructs for ankle arthrodesis. When clinically appropriate, screw-only ankle arthrodesis constructs could be considered if there is a need to reduce costs.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

背景

人们越来越关注与常见骨科手术相关的手术成本。在本研究中，我们研究了与胫距关节融合术相关的手术成本。

方法

根据2014年至2020年的（）编码，回顾性确定接受胫距关节初次融合术的患者。使用价值驱动结果（VDO）工具，我们对总直接成本和与设施相关的费用进行了评估。VDO工具包含一个全面的项目级数据库，能够捕获详细的成本信息，随后将其呈现为相对均值数据。对成本变量进行调整以反映2022年美元价值，并使用广义线性模型对成本进行比较多变量分析，以调整人口统计学变量后的治疗组为基础，得出成本比率以及95%置信区间。

结果

我们的队列包括262例接受初次踝关节融合手术的患者，这些手术由4名接受过足踝专科培训的骨科足踝外科医生之一进行。根据手术结构（单纯螺钉固定n = 228例与前路钢板螺钉固定n = 34例），人口统计学数据或总手术室（OR）时间没有差异。调整其他变量后，前路钢板螺钉固定结构的总直接成本比单纯螺钉固定高78%（成本比率 = 1.78，95%置信区间1.55 - 2.08，P <.001）。对于所有融合结构，总OR时间每增加1小时，总直接成本增加29%（成本比率 = 1.29，95%置信区间1.18 - 1.40，P <.001）。