Factors Affecting Cost Variation for Surgical Treatment of Thumb Carpometacarpal Arthritis: Ligament Reconstruction Tendon Interposition (LRTI) Versus Suture Suspension Arthroplasty (SSA)
Brittany N Garcia, MD1; Madeline Owen, BS1; James Kim, BS2; Chong Zhang, MS3; Angela P. Presson, PhD3; Nikolas H. Kazmers, MD MSE1
1University of Utah, Salt Lake City, UT; 2University of Utah Hospital, Salt Lake City, UT; 3Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT
Introduction: Ligament reconstruction tendon interposition (LRTI) and suture suspension arthroplasty (SSA) are two common methods used in the surgical treatment of degenerative thumb carpometacarpal (CMC) osteoarthritis (OA). The techniques differ significantly, yet both provide similar clinical outcomes. The purpose of this study was to evaluate factors affecting cost for patients undergoing LRTI or SSA. We hypothesized that operative time would be the most significant factor affecting cost between the two procedures.
Materials and Methods: Patients undergoing LRTI or SSA for thumb CMC arthritis at a single academic institution between 2014 – 2022 were identified. Total direct costs (TDC) for each surgical procedure were determined utilizing our institutions information technology cost data and converted to 2021 US dollars. Univariable gamma regressions were performed to assess association with total direct cost for each demographic and surgical variable. Regression coefficients were exponentiated to represent ratio in the cost. Multivariable regressions were performed to compare total direct cost between SSA and LRTI procedures. Wilcoxon rank sum tests were used to compare costs between the two groups.
Results: Of the 376 procedures included in this study 321 underwent LRTI and 55 underwent SSA. Patients had a mean age of 63.4 ± 8.0 years and 71% were female. Factors independently associated with increased costs included longer surgery time (1.73 [95% CI 1.58-1.89]), ASA class (4 vs 1)(1.49 [CI 1.20-1.87]) , anesthesia type (regional vs general) (0.80 [CI 0.74-0.85]) , surgeon, and surgery location (outpatient center vs not)(0.76[CI 0.68-0.84]). Mean surgical time for LRTI was 65.9 ± 14.6 compared to 59.1 ± 14.9 for SSA (p = .002). Procedures completed by attending physicians alone were significantly faster than those done in conjunction with a trainee and procedures with both a resident and fellow present took longer (p<.001). The TDC between LRTI and SSA was not significant (p = 0.06).
Conclusions: Several factors appear to influence cost in patients undergoing surgery for CMC OA. Sicker patients (ASA class 4) were nearly 50% more expensive than healthy patients, while surgery at an outpatient surgery center was 24% more cost effective than those performed at inpatient facilities. Surgical time was 10% faster for SSA than for LRTI but total direct costs are similar.
Acknowledgement: Investigation supported by University of Utah Study Design and Biostatistics Center, with funding in part from National Center for Research Resources and National Center for Advancing Translational Sciences, NIH, (Grant UL1TR002538 (formerly 5UL1TR001067-05, 8UL1TR000105 and UL1RR025764).
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