Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study.
J Shoulder Elbow Surg
; 30(1): 113-119, 2021 Jan.
Article
in En
| MEDLINE
| ID: mdl-32807371
ABSTRACT
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Shoulder Joint
/
Arthroplasty, Replacement, Shoulder
/
Orthopedic Surgeons
Type of study:
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
J Shoulder Elbow Surg
Journal subject:
ORTOPEDIA
Year:
2021
Document type:
Article
Affiliation country:
United States