Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study
Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study
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DOI：
10.1016/j.jse.2020.04.033
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发表时间：
2021-01-01
影响因子：
3
通讯作者：
Jawa, Andrew
中科院分区：
文献类型：
--
作者：
Carducci, Michael P.;Mahendraraj, Kuhan A.;Jawa, Andrew
背景：尽管全肩关节置换术的需求迅速增加，但描述成本趋势的数据很少。我们的目的是(1)描述由不同的外科医生在多家医院进行的肩关节置换手术的成本差异，(2)确定这种差异的驱动因素。方法：采用标准化、高精度的成本核算方法，即时间驱动的作业成本法，确定2016年至2018年4家大容量机构12名外科医生进行的1571例肩关节置换术的成本。成本分为供应成本（包括植入物价格和耗材）和人员成本（包括医生费用）。成本参数比较手术次数和病例量的总成本。结果：在4家机构和12名外科医生中，外科医生数量和医院数量与护理费用无关。解剖全肩关节置换术（TSA）和反向全肩关节置换术（RSA）的每例平均费用分别为1.6 （P = 0.47）和1.7 （P = 0.06）。植入物（分别为56%和62%）和从登记到手术室的人员成本（分别为21%和17%）代表了成本的最高百分比，并且与TSA和RSA的护理费用高度相关。结论：在4家高容量机构中，TSA和RSA的护理总成本的变化与医院或外科医生的病例量无关，但主要由植入物和手术室人员成本的变化驱动。这种分析不涉及中期或长期成本。(C) 2020年《肩关节外科杂志》理事会理事。版权所有。
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. (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.