Increased Provider Surgical Volume Decreases Procedural Costs in the Repair of Distal Radius Fractures
Kevin G Hu, BA1, Alexander J Kammien, BS1, Mica CG Williams, B.S.2, Fortunay Diatta, MD, MBE2, K Lynn Zhao, MD1, Brogan Evans, MD1 and David L Colen, MD2, (1)Yale School of Medicine, New Haven, CT, (2)Yale University School of Medicine, New Haven, CT
The cost of open reduction and internal fixation (ORIF) of distal radius fractures (DRF) is largely attributed to the choice of hardware for fixation, but no studies have examined the impact of surgical volume on costs. This study examines whether surgeons who perform DRF fixation more frequently can decrease procedural costs.
Materials & Methods:
This study analyzed encounter-level data from the Florida State Ambulatory Surgery and Services database between 2015- 2020. Patients undergoing ORIF for distal radius fractures were identified by CPT code 25607 and ICD-10 code S52.5. Patients were grouped by attending surgeon. The upper tertile of surgeons by case volume was compared with the lower tertile of surgeons using the Mann-Whitney U-test. Overall charges and component charges were compared.
7,182 patients underwent DRF fixation with average age 58.9 ± 18.0 years and 1,493 males (20.8%). The most frequent payer was Medicare or Medicaid (n = 3490, 48.6%), followed by private insurance (n = 2743, 38.2%). One-way ANOVA found no significant effect of payer on total charges (p = 0.84). These procedures were performed by 957 surgeons.
ORIFs performed by the upper tertile of surgeons by case volume had lower total charges than the bottom tertile of operating surgeons ($33,010 vs $40,382, p < 0.001) and lower operating room charges ($15,168 vs $19,336, p < 0.001). On univariate linear regression, the number of cases performed a surgeon significantly predicted total charges (b = -232.55, p < 0.001, r2 = 0.02), operating room charges (b = -132.96, p < 0.001, r2 = 0.02), radiology/imaging charges (b = -19.03, p = 0.004, r2 = 0.01), and anesthesia charges (b = -41.33, p < 0.001, r2 = 0.02). Case number tertile was neither associated with surgical supply charges (lowest tertile: $6,291; highest tertile: $6,525; p = 0.272) nor predictive of surgical supply charges (b = -10.53, p = 0.45, r2 < 0.01). Multivariate linear regression including procedure year, patient age, sex, and ZIP code median household income quartile found surgical volume continued to predict total charges (b = -124.32, p < 0.001, r2 = 0.05).
Increased surgical volume significantly decreases the cost of DRF fixation with respect to charges for the operating room, imaging, and anesthesia services, but not surgical supply. Increased surgeon experience may play a role in reducing resource utilization, resulting in decreased costs.
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