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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Patient- and Procedure-Specific Variables Driving Total Direct Costs of Outpatient Anterior Cruciate Ligament Reconstruction
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Patient- and Procedure-Specific Variables Driving Total Direct Costs of Outpatient Anterior Cruciate Ligament Reconstruction

机译：特定于患者和手术的变量驱动门诊前十字韧带重建的总直接成本

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Background: Few studies have investigated the influence of patient-specific variables or procedure-specific factors on the overall cost of anterior cruciate ligament reconstruction (ACLR) in an ambulatory surgery setting. Purpose: To determine patient- and procedure-specific factors influencing the overall direct cost of outpatient arthroscopic ACLR utilizing a unique value-driven outcomes (VDO) tool. Study Design: Cohort study (economic and decision analysis); Level of evidence, 3. Methods: All ACLRs performed by 4 surgeons over 2 years were retrospectively reviewed. Cost data were derived from the VDO tool. Patient-specific variables included age, body mass index, comorbidities, American Society of Anesthesiologists (ASA) classification, smoking status, preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computerized Adaptive Testing (PF-CAT) score, and preoperative Single Assessment Numeric Evaluation (SANE) score. Procedure-specific variables included graft type, revision status, associated injuries and procedures, time from injury to ACLR, surgeon, and operating room (OR) time. Multivariate analysis determined patient- and procedure-related predictors of total direct costs. Results: There were 293 autograft reconstructions, 110 allograft reconstructions, and 31 hybrid reconstructions analyzed. Patient-specific factors did not significantly influence the ACLR cost. The mean OR time was shorter for allograft reconstruction ( P < .001). Predictors of an increased direct cost included the use of an allograft or hybrid graft (44.5% and 33.1% increase, respectively; P < .001), increased OR time (0.3% increase per minute; P < .001), surgeon 3 or 4 (9.1% or 5.9% increase, respectively; P < .001 or P = .001, respectively), and concomitant meniscus repair (24.4% increase; P < .001). Within the meniscus repair cohort, all-inside, root, and combined repairs correlated with a 15.5%, 31.4%, and 53.2% increased mean direct cost, respectively, compared with inside-out repairs ( P < .001). Conclusion: This study failed to identify modifiable patient-specific factors influencing direct costs of ACLR. Allografts and hybrid grafts were associated with an increased total direct cost. Meniscus repair independently predicted an increased direct cost, with all-inside, root, and combined repairs being costlier than inside-out repairs. The time-saving potential of all-inside meniscus repair was not realized in this study, making implant use a significant factor in the overall cost of ACLR with meniscus repair.
机译：背景：很少有研究调查非门诊手术环境中患者特定变量或特定过程因素对前十字韧带重建（ACLR）总体成本的影响。目的：利用独特的价值驱动成果（VDO）工具，确定影响门诊关节镜ACLR总体直接费用的特定于患者和手术的因素。研究设计：队列研究（经济和决策分析）;证据级别：3。方法：回顾性回顾了4位外科医生在2年内进行的所有ACLR。成本数据来自VDO工具。患者特定的变量包括年龄，体重指数，合并症，美国麻醉医师学会（ASA）分类，吸烟状况，术前患者报告的结果测量信息系统（PROMIS）身体机能计算机自适应测试（PF-CAT）得分以及术前单一评估数值评估（SANE）分数。特定于程序的变量包括移植物类型，翻修状态，相关的伤害和程序，从受伤到ACLR的时间，外科医生和手术室（OR）时间。多变量分析确定了与患者和手术相关的总直接费用的预测因素。结果：分析了293例自体移植物重建，110例异体移植物重建和31例杂交重建。患者特定因素并未显着影响ACLR费用。同种异体重建的平均OR时间较短（P <.001）。直接成本增加的预测因素包括使用同种异体移植或混合移植（分别增加44.5％和33.1％; P <.001），手术时间增加（每分钟增加0.3％; P <.001），外科医生3或4（分别增加9.1％或5.9％; P <.001或P = .001），同时进行半月板修复（增加24.4％; P <.001）。在半月板修复队列中，与由内而外的修复相比，全内，根和联合修复分别使平均直接成本增加了15.5％，31.4％和53.2％（P <.001）。结论：该研究未能发现影响ACLR直接费用的可改变的患者特异性因素。同种异体移植和杂种移植与直接总成本增加有关。半月板维修独立地预测直接成本会增加，而全内，根和组合维修要比由内而外的维修花费更高。在这项研究中，没有实现节省全部内侧半月板的省时潜力，这使得植入物在半月板修复的ACLR总体成本中成为重要因素。

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