Surgical Costs Associated with Tibiotalar Fusion

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is growing focus on the surgical costs related to common orthopedic procedures. In this investigation, we studied the costs associated with tibiotalar arthrodesis by comparing different surgical constructs (screws-alone vs. plate-screw fixation). Methods: Patients were retrospectively identified who had undergone primary fusion of the tibiotalar joint based on CPT codes from 2014 to 2020. Utilizing the Value Driven Outcome (VDO) tool implemented at our institution, we conducted an evaluation of both total direct costs and facility-related expenses. The VDO tool encompasses a comprehensive item-level database capable of capturing detailed cost information, which is subsequently presented as relative mean data. Adjustments were made to cost variables to reflect 2022 US dollars, and comparative analysis of costs in relation to treatment groups and other exposure variables was performed using generalized linear models to yield cost ratios along with 95% confidence intervals (CIs). Results: Our cohort consisted of 263 patients who underwent primary ankle fusion procedures done by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographic data or total OR time based on surgical construct (screws-alone N =229, plate-screws N =34). Total direct cost for plate-screw constructs were 72% higher than screws alone (ratio in cost =1.72, 95% CI 1.49~2.03, p< 0.001). There was no significant difference in regression analysis between plate-screw vs screws-alone for facility cost (ratio in cost =1.14, 95% CI: 0.99~1.34, p=0.10). For all fusion constructs, every 1 hour increase in total OR time increases total direct costs by 28% (ratio in cost =1.28, 95% CI 1.18~1.40, p< 0.001). Conclusion: Enhancing the cost-effectiveness of orthopedic care remains an important objective. Our investigation suggests that screw-only constructs, compared to plate-screw constructs, can notably lower overall total costs by 72%. Many variables are considered when selecting surgical constructs for ankle arthrodesis. When clinically appropriate, screw-only ankle arthrodesis constructs could be considered if there is a need to reduce overall total costs.