Ankle fractures: High implant cost is not associated with better patient reported outcomes

Kibble, Kendra; Cunningham, Brian; Rivard, Rachael L.; Vang, Sandy; Nguyen, Mai P.

doi:10.1016/j.injury.2023.110963

Cited by 1 publication

(3 citation statements)

References 27 publications

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“…However, these factors were not found to be associated with cost in our linear mixed model. Our data analysis is consistent with evidence found by Kibble et al, 5 who did not find osteoporosis and age did not affect the cost of implants.…”

Section: Discussionsupporting

confidence: 93%

“…Costs of health care in the United States continues to rise and practitioners are being held accountable to help mitigate direct patient and health care costs. 9 Kibble et al 5 showed significant variability in ankle implant cost, with no correlation between higher cost implants and better patient outcomes. Orthopaedic surgeons have a unique opportunity to help decrease health care cost by lowering implant costs.…”

Section: Discussionmentioning

confidence: 99%

“…We did find that a patient’s fracture pattern can influence the cost of the implant construct, but this is beyond a surgeons’ control. With no significant association between patient outcomes and ankle implant costs, 5 further study is warranted to identify what influences surgeon behavior and how strategies can assist orthopaedic surgeons in lower implant costs.…”

Section: Discussionmentioning

confidence: 99%

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Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?

Swenson,

Paull,

Moua

et al. 2024

Foot & Ankle Orthopaedics

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Background: Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior. Methods: Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey. Results: The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was −$204.80 ( P = .68), whereas the mean cost difference for bimalleolar fractures was −$9.82 ( P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 ( P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs ( P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study. Conclusion: The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone. Level of Evidence: Level III, case control study.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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