Comparison of Direct Surgical Costs for Proximal Row Carpectomy and Four-Corner Arthrodesis

Abstract

Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common treatments for stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, with similar functional and patient-reported outcomes reported in the peer-reviewed literature. Questions Study questions included (1) whether surgical encounter total direct costs (SETDCs) differ between PRC and FCA, and (2) whether SETDC differs by method of fixation for FCA. Patients and Methods Consecutive adult patients (≥ 18 years) undergoing PRC and FCA between July 2011 and May 2017 at a single tertiary care academic institution were identified. Patients undergoing additional simultaneous procedures were excluded. Using our institution's information technology value tools, we extracted prospectively collected cost data for each surgical encounter. SETDCs were compared between PRC and FCA, and between FCA subgroups (screws, plating, or staples). Results Of 42 included patients, mean age was similar between the 23 PRC and 19 FCA patients (51.2 vs. 54.5 years, respectively). SETDCs were significantly greater for FCA than PRC by 425%. FCA involved significantly greater facility costs (2.3-fold), supply costs (10-fold), and operative time (121 vs. 57 minutes). Implant costs were absent for PRC, which were responsible for 55% of the SETDC for FCA. Compared with compression screws, plating and staple fixation were significantly more costly (70% and 240% greater, respectively). Conclusion SETDCs were 425% greater for FCA than PRC. Implant costs for FCA alone were 130% greater than the entire surgical encounter for PRC. For FCA, SETDC varied depending on the method of fixation. Level of Evidence This is a level III, cost analysis study.

Evaluation of factors driving cost variation for distal humerus open reduction internal fixation

“… 16 , 19 Identification of factors that drive cost differences for various orthopedic conditions or injuries has been demonstrated in previously published studies. 19 , 20 , 21 , 27 , 48 Orthopedic surgeons consider cost to be an important factor when determining optimal treatment, 17 , 50 yet they have a poor understanding of factors that affect cost variation and are likely to underestimate costs. 4 , 33 , 43 , 50 Surgeon awareness of cost differences between implants used in distal humerus and other common upper extremity fractures may significantly impact a surgeon's choice of surgical implant.…”

“…Not surprisingly, increased surgical time increased costs 5 , 10 , 19 , 21 associated with distal humerus ORIF. Each additional hour of operating time increased costs by 15%.…”

Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature

“…Noted that TWA is also a salvage option after failed 4CF or PRC [9, 82 -84]. Last but not the least, the total costs are 425% greater for 4CF than PRC, implant costs for 4CF alone are 130% greater than the entire surgical encounter for PRC, and costs for plates and staples for 4CF are 70% and 240% greater relative to screws [85].…”