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

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ID: 69139
2019
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Abstract
The optimal surgical treatment of anterior shoulder instability remains controversial.(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.Cross-sectional study; Level of evidence, 3.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.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 ( = .007) and whether the procedure was performed in an ambulatory or inpatient setting ( < .0001) to be significantly associated with higher direct costs.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.
Reference Key
uffmann2019aorthopaedic Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Uffmann, William J;Christensen, Garrett V;Yoo, Minkyoung;Nelson, Richard E;Greis, Patrick E;Burks, Robert T;Tashjian, Robert Z;Chalmers, Peter N;
Journal Orthopaedic journal of sports medicine
Year 2019
DOI
10.1177/2325967119882001
URL
Keywords
cost latarjet shoulder instability arthroscopic bankart distal tibial allograft

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