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Tytuł:
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Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study.
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Autorzy:
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Carducci MP; New England Baptist Hospital, Boston, MA, USA.
Mahendraraj KA; New England Baptist Hospital, Boston, MA, USA.
Menendez ME; Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA.
Rosen I; Avant-garde Health, Boston, MA, USA.
Klein SM; Department of Orthopaedic Surgery, Gundersen Health System, La Crosse, WI, USA.
Namdari S; Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Ramsey ML; Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Jawa A; New England Baptist Hospital, Boston, MA, USA. Electronic address: .
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Źródło:
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Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2021 Jan; Vol. 30 (1), pp. 113-119. Date of Electronic Publication: 2020 Jun 09.
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Typ publikacji:
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Journal Article; Multicenter Study
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Język:
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English
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Imprint Name(s):
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Publication: St. Louis, MO : Mosby
Original Publication: St. Louis, MO : Mosby Yearbook, Inc., c1992-
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MeSH Terms:
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Arthroplasty, Replacement, Shoulder*/economics
Arthroplasty, Replacement, Shoulder*/instrumentation
Arthroplasty, Replacement, Shoulder*/statistics & numerical data
Shoulder Joint*/surgery
Orthopedic Surgeons/*economics
Costs and Cost Analysis ; Economics, Hospital/statistics & numerical data ; Episode of Care ; Hospital Costs/statistics & numerical data ; Hospitals/statistics & numerical data ; Hospitals, High-Volume/statistics & numerical data ; Humans ; Orthopedic Surgeons/statistics & numerical data ; Retrospective Studies ; Shoulder Prosthesis/economics ; United States/epidemiology
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Contributed Indexing:
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Keywords: Time-driven activity-based costing; anatomic total shoulder arthroplasty; cost accounting; episode of care; multicenter; reverse total shoulder arthroplasty
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Entry Date(s):
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Date Created: 20200819 Date Completed: 20210614 Latest Revision: 20210614
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Update Code:
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20240104
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DOI:
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10.1016/j.jse.2020.04.033
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PMID:
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32807371
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Background: Despite rapid increases in the demand for total shoulder arthroplasty, data describing cost trends are scarce. We aim to (1) describe variation in the cost of shoulder arthroplasty performed by different surgeons at multiple hospitals and (2) determine the driving factors of such variation.
Methods: A standardized, highly accurate cost accounting method, time-driven activity-based costing, was used to determine the cost of 1571 shoulder arthroplasties performed by 12 surgeons at 4 high-volume institutions between 2016 and 2018. Costs were broken down into supply costs (including implant price and consumables) and personnel costs, including physician fees. Cost parameters were compared with total cost for surgical episodes and case volume.
Results: Across 4 institutions and 12 surgeons, surgeon volume and hospital volume did not correlate with episode-of-care cost. Average cost per case of each institution varied by factors of 1.6 (P = .47) and 1.7 (P = .06) for anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA), respectively. Implant (56% and 62%, respectively) and personnel costs from check-in through the operating room (21% and 17%, respectively) represented the highest percentages of cost and highly correlated with the cost of the episode of care for TSA and RSA.
Conclusions: Variation in episode-of-care total costs for both TSA and RSA had no association with hospital or surgeon case volume at 4 high-volume institutions but was driven primarily by variation in implant and personnel costs through the operating room. This analysis does not address medium- or long-term costs.
(Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
