Back to 2025 Abstracts
Patient-Level Value Analysis for CMC Arthroplasty: How is Procedure Type Associated with Value of Care?
Rebekah M Kleinsmith, MD
1; Stephen A Doxey, DO
1; Haley D Puckett, MD
1; Issa Mutyaba, BS
2; Andrew C Sibley, BS
3; Lauren M Shapiro, MD
4; Jeffrey B Husband, MD
1; Brian P Cunningham, MD
51TRIA Orthopedic Center, Bloomington, MN; 2University of Minnesota, Minneapolis, MN; 3Orthopaedics, University of Minnesota, Minneapolis, MN; 4University of California, San Francisco, San Francisco, CA; 5Park Nicollet Methodist Hospital, Minneapolis, MN
IntroductionThe purpose of this study is to analyze factors that influence value on the patient level during a 6-month episode of care after CMC arthroplasty.
Materials and MethodsAll patients that received primary CMC arthroplasty using ligament reconstruction tendon interposition (LRTI), suture suspensionplasty or InteralBrace suspensionplasty techniques between 2018 and 2022 were eligible for inclusion. Patients that had incomplete patient-reported outcomes, complicated postoperative course, required return to the OR, sustained trauma to the operative hand/wrist, or had subsequent operations on the affected hand/wrist within the 6-month episode of care were excluded from analysis. Patient-reported outcomes were prospectively collected and stored for retrospective review for this study. The patient-reported wrist and hand evaluation (PRWE) was collected for each patient at baseline and 6 months. Costs for the 6-month episode of care were calculated using time-driven activity-based costing methodology and were adjusted for inflation to represent 2023 USD. Value was calculated by dividing 6-month change in PRWE by total 6-month cost of care and converted to a z-score. Statistical analyses included descriptive analyses, t-tests, chi-squared tests, ANOVA, and linear regression.
ResultsOf the 154 patients included in analysis, 110 (71.4%) were women with an average age of 63.7±7.5 years. The average baseline PRWE score was 62.0±18.5 with an average decrease (symptom improvement) of 44.3±22.6 over the 6-month episode of care. Total cost for the 6-month episode of care averaged $3,085.15±$625.88. There was no significant difference between average change in PRWE between procedure types (p=0.131). Procedure type and baseline PRWE were predictive of value and together accounted for 52.8% of variation in the value coefficient (p<0.001). Higher baseline PRWE scores (higher symptom burden) correlated with increased value of care (r=0.67, p<0.001). Suture suspensionplasty resulted in a higher average value coefficient than InternalBrace suspensionplasty (p<0.001) and trapeziectomy with LRTI, though this did not reach statistical significance (p=0.056,
f=0.25).
ConclusionsSurgical technique is significantly associate with value of patient care received in the management of thumb CMC arthritis. Suture suspensionplasty results in similar improvement in patient-reported outcomes as LRTI and Internalbrace suspensionplasty while providing higher-value care to patients.
Back to 2025 Abstracts
