Dean Michael C, Cherian Nathan J, Beck da Silva Etges Ana Paula, Dowley Kieran S, Torabian Kaveh A, LaPorte Zachary L, Martin Scott D
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.
Am J Sports Med. 2025 Jul;53(8):1869-1877. doi: 10.1177/03635465251341463. Epub 2025 Jun 5.
Amid mounting pressure to reduce health care spending, strategies for identifying and eliminating unwarranted variation in costs have garnered significant attention. Previous studies have characterized intersurgeon variation in costs for common orthopaedic procedures, but such variation remains unexplored in the context of hip arthroscopic surgery.
To (1) characterize variation in the cost of hip arthroscopic surgery between surgeons using time-driven activity-based costing (TDABC) and (2) identify patient characteristics, intraoperative findings, and operative procedures underlying such intersurgeon variation in costs.
Cohort study; Level of evidence, 3.
Employing TDABC, the authors determined the intraoperative cost of 890 outpatient hip arthroscopic surgery cases performed by 5 surgeons at 4 surgery centers from 2015 to 2022. All costs were calculated in United States dollars. Costs were normalized to protect the confidentiality of internal hospital cost data. Surgeon-specific mean costs were calculated with and without adjustment for patient characteristics, surgical personnel, operative factors, and surgery center. Finally, to elucidate the sources of surgeon-driven cost variation, the authors estimated the proportion of variation attributable to different cost subcategories, including labor, implant/allograft, and other supply costs.
The intraoperative cost per patient ranged from 38.2 to 212.8 normalized cost units (mean, 100.0 ± 26.5), with a 1.6-fold variation in the mean cost between the highest and lowest cost surgeons. Operating surgeon alone explained 53.4% of the observed variation in costs. Controlling for case-specific features significantly improved the explanatory power to 91.8% ( < .001), but the adjusted variation in costs between surgeons remained essentially unchanged (decreased by <3%). Each of the 5 surgeons generated costs that deviated significantly from those predicted based on case-specific factors, with mean surgeon deviations ranging from -5.0% to 21.8% ( < .001 for all). Drivers of cost variation differed substantially between surgeons but generally stemmed from labor or other supply costs rather than implant/allograft costs.
The cost of outpatient hip arthroscopic surgery varied widely between surgeons; the cause of this deviation was multifactorial and surgeon specific. While within-surgeon cost variation was effectively explained by patient and operative characteristics, most between-surgeon variability remained unexplained by observable factors. These insights may support individual surgeons in cost reduction efforts and, more importantly, may enable the alignment of reimbursement rates with costs.
在降低医疗保健支出的压力不断增加的情况下，识别和消除不必要的成本差异的策略已引起广泛关注。先前的研究已经描述了普通骨科手术中外科医生之间的成本差异，但在髋关节镜手术中这种差异仍未得到探索。
（1）使用时间驱动作业成本法（TDABC）描述外科医生之间髋关节镜手术成本的差异，（2）确定这种外科医生间成本差异背后的患者特征、术中发现和手术操作。
队列研究；证据等级，3级。
作者采用TDABC法，确定了2015年至2022年期间5位外科医生在4个手术中心进行的890例门诊髋关节镜手术病例的术中成本。所有成本均以美元计算。为保护医院内部成本数据的保密性，成本进行了标准化处理。计算了外科医生特定的平均成本，并对患者特征、手术人员、手术因素和手术中心进行了调整与未调整的情况。最后，为阐明外科医生驱动的成本差异来源，作者估计了不同成本子类别（包括人工、植入物/同种异体移植物和其他供应成本）导致的差异比例。
每位患者的术中成本范围为38.2至212.8个标准化成本单位（平均，100.0±26.5），成本最高和最低的外科医生之间的平均成本相差1.6倍。仅手术医生就解释了观察到的成本差异的53.4%。控制病例特定特征后，解释力显著提高至91.8%（P<0.001），但外科医生之间调整后的成本差异基本保持不变（下降<3%）。5位外科医生各自产生的成本均与基于病例特定因素预测的成本有显著偏差，外科医生的平均偏差范围为-5.0%至21.8%（所有P<0.001）。不同外科医生的成本差异驱动因素差异很大，但一般源于人工或其他供应成本，而非植入物/同种异体移植物成本。
门诊髋关节镜手术的成本在外科医生之间差异很大；这种偏差的原因是多因素的且因外科医生而异。虽然患者和手术特征有效地解释了外科医生内部的成本差异，但大多数外科医生之间的差异仍无法用可观察因素来解释。这些见解可能有助于个体外科医生进行成本降低努力，更重要的是，可能使报销率与成本保持一致。
