Arthroscopic versus Open Ankle Arthrodesis: A Retrospective Cost Analysis

• Published in: The Journal of foot and ankle surgery Vol. 49; no. 3; pp. 242 - 247
• Main Authors: Peterson, Kyle S., BS, Lee, Michael S., DPM, FACFAS, Buddecke, Donald E., DPM, FACFAS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2010; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures - economics; Ambulatory Surgical Procedures - methods; ankle; Ankle Joint - physiopathology; Ankle Joint - surgery; Arthritis - diagnosis; Arthritis - surgery; Arthrodesis - economics; Arthrodesis - methods; Arthroscopy; Arthroscopy - economics; Arthroscopy - methods; Biological and medical sciences; Chi-Square Distribution; Cohort Studies; Cost Savings; Cost-Benefit Analysis; cost-effectiveness; Diseases of the osteoarticular system; Endoscopy; Female; Follow-Up Studies; fusion; Humans; Inpatients - statistics & numerical data; Investigative techniques, diagnostic techniques (general aspects); Length of Stay - economics; Male; Medical sciences; Middle Aged; Orthopedic Procedures - economics; Orthopedic Procedures - methods; Orthopedic surgery; Orthopedics; Retrospective Studies; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; fusion; cost-effectiveness; arthroscopy; 3; ankle; Costs; Ankle; Ankle joint; Arthroscopy; Treatment; Surgery; Health economy; Orthopedics; Arthrodesis; Endoscopy; Cost analysis; Public health; Comparative study
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2010.02.019

Abstract Compared with traditional open arthrodesis, arthroscopic ankle arthrodesis has been associated with similar rates of fusion, decreased time to union, decreased pain, shorter hospital stay, earlier mobilization, reliable clinical results, and fewer complications. The aim of this case-control study was to analyze cost differences between outpatient arthroscopic and inpatient open ankle arthrodesis. To this end, the authors analyzed 20 ankle arthrodesis procedures: 10 performed by one surgeon on an inpatient basis using an open approach, and 10 performed by another surgeon on an outpatient basis arthroscopically. Patient age, body mass index, tourniquet time, length of stay, complications, days to clinical union, and insurance type, as well as charges and reimbursements for the surgeons and the hospital or surgery center were abstracted from the records. Statistically significant differences were observed between the outpatient arthroscopic and inpatient open arthrodesis groups for total site charges ($3898 ± 0.00 versus $32,683 ± $12,762, respectively, P < .0001), reimbursement to the surgeon ($1567 ± $320 versus $1107 ± $278, respectively, P = .003), and reimbursement to the hospital or ambulatory surgery center ($1110 ± $287 versus $8432 ± $2626, respectively); the ratio of hospital/surgery center charges to hospital/surgery center reimbursements was 28.48% for the inpatient arthroscopic group and 25.80% for the inpatient open arthrodesis group. Outpatient arthroscopic ankle arthrodesis, compared with inpatient open ankle arthrodesis, appears to be less expensive for third party payers, and surgeons are paid more, whereas hospitals and ambulatory surgical centers get paid a greater proportion of the charges that they bill.