Cargando…

A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft

BACKGROUND: The optimal surgical treatment of anterior shoulder instability remains controversial. HYPOTHESIS: (1) Implants and facility-related costs are the primary drivers of variation in direct costs between arthroscopic Bankart and Latarjet procedures, and (2) distal tibial allograft (DTA) is m...

Descripción completa

Detalles Bibliográficos
Autores principales: Uffmann, William J., Christensen, Garrett V., Yoo, Minkyoung, Nelson, Richard E., Greis, Patrick E., Burks, Robert T., Tashjian, Robert Z., Chalmers, Peter N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873280/
https://www.ncbi.nlm.nih.gov/pubmed/31799329
http://dx.doi.org/10.1177/2325967119882001
_version_ 1783472635728887808
author Uffmann, William J.
Christensen, Garrett V.
Yoo, Minkyoung
Nelson, Richard E.
Greis, Patrick E.
Burks, Robert T.
Tashjian, Robert Z.
Chalmers, Peter N.
author_facet Uffmann, William J.
Christensen, Garrett V.
Yoo, Minkyoung
Nelson, Richard E.
Greis, Patrick E.
Burks, Robert T.
Tashjian, Robert Z.
Chalmers, Peter N.
author_sort Uffmann, William J.
collection PubMed
description BACKGROUND: The optimal surgical treatment of anterior shoulder instability remains controversial. HYPOTHESIS: (1) Implants and facility-related costs are the primary drivers of variation in direct costs between arthroscopic Bankart and Latarjet procedures, and (2) distal tibial allograft (DTA) is more costly than Latarjet as a function of the graft expense. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Intraoperative cost data were derived for all arthroscopic anterior stabilizations and Latarjet and DTA procedures performed at a single academic institution from January 2012 to September 2017. Cost comparisons were made between those undergoing arthroscopic stabilization and Latarjet and between Latarjet and DTA. Multivariate regressions were performed to determine the difference in direct costs accounting for various patient- and surgery-related factors. RESULTS: A total of 87 arthroscopic stabilizations, 44 Latarjet procedures, and 5 DTA procedures were performed during the study period. Arthroscopic Bankart repair was found to be 17% more costly than Latarjet, with suture anchor implant cost being the primary driver of cost. DTA was 2.9-fold more costly than Latarjet, with greater costs across all domains. Multivariate analysis also found the number of prior arthroscopic procedures performed (P = .007) and whether the procedure was performed in an ambulatory or inpatient setting (P < .0001) to be significantly associated with higher direct costs. CONCLUSION: Latarjet is less costly than arthroscopic Bankart repair, largely because of implant cost. Value-driven strategies to narrow the cost differential could focus on performing these procedures in an outpatient setting in addition to reducing overall implant cost for arthroscopic procedures. Perceived potential benefits of DTA over Latarjet may be outweighed by higher costs.
format Online
Article
Text
id pubmed-6873280
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-68732802019-12-03 A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft Uffmann, William J. Christensen, Garrett V. Yoo, Minkyoung Nelson, Richard E. Greis, Patrick E. Burks, Robert T. Tashjian, Robert Z. Chalmers, Peter N. Orthop J Sports Med Article BACKGROUND: The optimal surgical treatment of anterior shoulder instability remains controversial. HYPOTHESIS: (1) Implants and facility-related costs are the primary drivers of variation in direct costs between arthroscopic Bankart and Latarjet procedures, and (2) distal tibial allograft (DTA) is more costly than Latarjet as a function of the graft expense. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Intraoperative cost data were derived for all arthroscopic anterior stabilizations and Latarjet and DTA procedures performed at a single academic institution from January 2012 to September 2017. Cost comparisons were made between those undergoing arthroscopic stabilization and Latarjet and between Latarjet and DTA. Multivariate regressions were performed to determine the difference in direct costs accounting for various patient- and surgery-related factors. RESULTS: A total of 87 arthroscopic stabilizations, 44 Latarjet procedures, and 5 DTA procedures were performed during the study period. Arthroscopic Bankart repair was found to be 17% more costly than Latarjet, with suture anchor implant cost being the primary driver of cost. DTA was 2.9-fold more costly than Latarjet, with greater costs across all domains. Multivariate analysis also found the number of prior arthroscopic procedures performed (P = .007) and whether the procedure was performed in an ambulatory or inpatient setting (P < .0001) to be significantly associated with higher direct costs. CONCLUSION: Latarjet is less costly than arthroscopic Bankart repair, largely because of implant cost. Value-driven strategies to narrow the cost differential could focus on performing these procedures in an outpatient setting in addition to reducing overall implant cost for arthroscopic procedures. Perceived potential benefits of DTA over Latarjet may be outweighed by higher costs. SAGE Publications 2019-11-21 /pmc/articles/PMC6873280/ /pubmed/31799329 http://dx.doi.org/10.1177/2325967119882001 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Uffmann, William J.
Christensen, Garrett V.
Yoo, Minkyoung
Nelson, Richard E.
Greis, Patrick E.
Burks, Robert T.
Tashjian, Robert Z.
Chalmers, Peter N.
A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft
title A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft
title_full A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft
title_fullStr A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft
title_full_unstemmed A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft
title_short A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft
title_sort cost-minimization analysis of intraoperative costs in arthroscopic bankart repair, open latarjet, and distal tibial allograft
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873280/
https://www.ncbi.nlm.nih.gov/pubmed/31799329
http://dx.doi.org/10.1177/2325967119882001
work_keys_str_mv AT uffmannwilliamj acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT christensengarrettv acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT yoominkyoung acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT nelsonricharde acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT greispatricke acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT burksrobertt acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT tashjianrobertz acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT chalmerspetern acostminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT uffmannwilliamj costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT christensengarrettv costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT yoominkyoung costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT nelsonricharde costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT greispatricke costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT burksrobertt costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT tashjianrobertz costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft
AT chalmerspetern costminimizationanalysisofintraoperativecostsinarthroscopicbankartrepairopenlatarjetanddistaltibialallograft