Download PDF
J Wrist Surg 2023; 12(04): 312-317
DOI: 10.1055/s-0042-1757439
Scientific Article

The Primary Cost Drivers of Outpatient Distal Radius Fracture Fixation: A Cost-Minimalization Analysis of 15,379 Cases

Andrew M. Hresko
1   Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Lambert T. Li
1   Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Steven L. Bokshan
1   Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Jeyvikram Thirumavalavan 
1   Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Joseph A. Gil
1   Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Distal radius fractures are the most common fracture of the upper extremity. While some distal radius fractures can be managed with closed reduction and immobilization, operative treatment is the standard of care, with open reduction internal fixation (ORIF) as a predominant operative method.

Questions/Purpose To investigate how patient and surgical characteristics affect the overall costs of internal fixation of distal radius fractures in adults.

Patients and Methods The 2014 State Ambulatory Surgery and Services Databases for six states were used to identify cases and surgical characteristics of distal radius fracture ORIF in adult patients.

Results Surgical variables that significantly increased cost were postoperative admission within 30 days, regional anesthesia, simultaneous endoscopic carpal tunnel release, and increasing operating room time.

Conclusion Substantial contributors to total cost are postoperative hospital admission within 30 days of surgery, use of regional anesthesia, simultaneous endoscopic carpal tunnel release, and longer operative time.

Level of Evidence Level III, retrospective cohort study.

Keywords

distal radius - cost drivers - outpatient surgery


Publication History

Received: 12 June 2022

Accepted: 01 August 2022

Article published online:
13 October 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma 2015; 29 (08) e242-e244
    CrossrefPubMedGoogle Scholar
  • 2 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28 (02) 113-125
    CrossrefPubMedGoogle Scholar
  • 3 Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (08) 1837-1846
    CrossrefPubMedGoogle Scholar
  • 4 Grewal R, MacDermid JC, King GJW, Faber KJ. Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg Am 2011; 36 (12) 1899-1906
    CrossrefPubMedGoogle Scholar
  • 5 Karantana A, Downing ND, Forward DP. et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am 2013; 95 (19) 1737-1744
    CrossrefPubMedGoogle Scholar
  • 6 Costa ML, Achten J, Parsons NR. et al; DRAFFT Study Group. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ 2014; 349: g4807
    CrossrefPubMedGoogle Scholar
  • 7 Mellstrand Navarro C, Ahrengart L, Törnqvist H, Ponzer S. Volar locking plate or external fixation with optional addition of K-wires for dorsally displaced distal radius fractures: a randomized controlled study. J Orthop Trauma 2016; 30 (04) 217-224
    CrossrefPubMedGoogle Scholar
  • 8 Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am 2009; 91 (06) 1313-1319
    CrossrefPubMedGoogle Scholar
  • 9 Chung KC, Shauver MJ, Yin H, Kim HM, Baser O, Birkmeyer JD. Variations in the use of internal fixation for distal radial fracture in the United States Medicare population. J Bone Joint Surg Am 2011; 93 (23) 2154-2162
    CrossrefPubMedGoogle Scholar
  • 10 Huetteman HE, Shauver MJ, Malay S, Chung T-T, Chung KC. Variation in the treatment of distal radius fractures in the United States: 2010 to 2015. Plast Reconstr Surg 2019; 143 (01) 159-167
    CrossrefPubMedGoogle Scholar
  • 11 Shauver MJ, Yin H, Banerjee M, Chung KC. Current and future national costs to Medicare for the treatment of distal radius fracture in the elderly. J Hand Surg Am 2011; 36 (08) 1282-1287
    CrossrefPubMedGoogle Scholar
  • 12 Huetteman HE, Zhong L, Chung KC. Cost of surgical treatment for distal radius fractures and the implications of episode-based bundled payments. J Hand Surg Am 2018; 43 (08) 720-730
    CrossrefPubMedGoogle Scholar
  • 13 Rajan PV, Qudsi RA, Dyer GSM, Losina E. The cost-effectiveness of surgical fixation of distal radial fractures: a computer model-based evaluation of three operative modalities. J Bone Joint Surg Am 2018; 100 (03) e13
    CrossrefPubMedGoogle Scholar
  • 14 Pang EQ, Truntzer J, Baker L, Harris AHS, Gardner MJ, Kamal RN. Cost minimization analysis of the treatment of distal radial fractures in the elderly. Bone Joint J 2018; 100-B (02) 205-211
    CrossrefPubMedGoogle Scholar
  • 15 Bokshan SL, Mehta S, DeFroda SF, Owens BD. What are the primary cost drivers of anterior cruciate ligament reconstruction in the United States? A cost-minimization analysis of 14,713 patients. Arthroscopy 2019; 35 (05) 1576-1581
    CrossrefPubMedGoogle Scholar
  • 16 Li L, Bokshan SL, Mehta SR, Owens BD. Disparities in cost and access by caseload for arthroscopic rotator cuff repair: an analysis of 18,616 cases. Orthop J Sports Med 2019; 7 (06) 2325967119850503
    CrossrefPubMedGoogle Scholar
  • 17 HCUP Databases. Healthcare Cost and Utilization Project (HCUP). 2006-2009. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/databases.jsp
    PubMed
  • 18 Churchill RS, Ghorai JK. Total cost and operating room time comparison of rotator cuff repair techniques at low, intermediate, and high volume centers: mini-open versus all-arthroscopic. J Shoulder Elbow Surg 2010; 19 (05) 716-721
    CrossrefPubMedGoogle Scholar
  • 19 Bekelis K, Missios S, Kakoulides G, Rahmani R, Simmons N. Selection of patients for ambulatory lumbar discectomy: results from four US states. Spine J 2014; 14 (09) 1944-1950
    CrossrefPubMedGoogle Scholar
  • 20 Williamson ERC, Vasquez Montes D, Melamed E. Multistate comparison of cost, trends, and complications in open versus endoscopic carpal tunnel release. Hand (N Y) 2021; 16 (01) 25-31
    CrossrefPubMedGoogle Scholar
  • 21 Li L, Bokshan SL, Ready LV, Owens BD. The primary cost drivers of arthroscopic rotator cuff repair surgery: a cost-minimization analysis of 40,618 cases. J Shoulder Elbow Surg 2019; 28 (10) 1977-1982
    CrossrefPubMedGoogle Scholar
  • 22 Batty M, Ippolito B. Mystery of the chargemaster: examining the role of hospital list prices in what patients actually pay. Health Aff (Millwood) 2017; 36 (04) 689-696
    CrossrefPubMedGoogle Scholar
  • 23 Kazmers NH, Judson CH, Presson AP, Xu Y, Tyser AR. Evaluation of factors driving cost variation for distal radius fracture open reduction internal fixation. J Hand Surg Am 2018; 43 (07) 606-614 .e1
    CrossrefPubMedGoogle Scholar
  • 24 Nandyala SV, Giladi AM, Parker AM, Rozental TD. Comparison of direct perioperative costs in treatment of unstable distal radial fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. J Bone Joint Surg Am 2018; 100 (09) 786-792
    CrossrefPubMedGoogle Scholar
  • 25 Zhong L, Mahmoudi E, Giladi AM, Shauver M, Chung KC, Waljee JF. Utilization of post-acute care following distal radius fracture among Medicare beneficiaries. J Hand Surg Am 2015; 40 (12) 2401-9 .e8
    CrossrefPubMedGoogle Scholar
  • 26 Mather III RC, Wysocki RW, Mack Aldridge III J, Pietrobon R, Nunley JA. Effect of facility on the operative costs of distal radius fractures. J Hand Surg Am 2011; 36 (07) 1142-1148
    CrossrefPubMedGoogle Scholar
  • 27 Koehler DM, Balakrishnan R, Lawler EA, Shah AS. Endoscopic versus open carpal tunnel release: a detailed analysis using time-driven activity-based costing at an academic medical center. J Hand Surg Am 2019; 44 (01) 62.e1-62.e9
    CrossrefPubMedGoogle Scholar
  • 28 Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral nerve blocks for hip fractures: a Cochrane review. Anesth Analg 2018; 126 (05) 1695-1704
    CrossrefPubMedGoogle Scholar
  • 29 Foster BD, Terrell R, Montgomery SR, Wang JC, Petrigliano FA, McAllister DR. Hospital charges and practice patterns for general and regional anesthesia in arthroscopic anterior cruciate ligament repair. Orthop J Sports Med 2013; 1 (05) 2325967113505270
    CrossrefPubMedGoogle Scholar
  • 30 Egol KA, Soojian MG, Walsh M, Katz J, Rosenberg AD, Paksima N. Regional anesthesia improves outcome after distal radius fracture fixation over general anesthesia. J Orthop Trauma 2012; 26 (09) 545-549
    CrossrefPubMedGoogle Scholar