Cost of Orthopaedic Trauma Surgery is Weakly Associated with Industry Payments to Surgeons.

Abstract

Objective: To examine the relationship between industry payments to surgeons and total cost of orthopaedic trauma surgery. Secondarily, to investigate the relationship between surgeon industry payments and operating room cost, length of stay, 30-day mortality, and 30-day readmission.

Methods: Design: Retrospective cross-sectional database study with minimum 30-day follow-up.

Setting: 20% sample of Medicare beneficiaries from January 2006 to December 2015 from the Medicare database.

Patient selection criteria: Medicare-insured patients undergoing orthopaedic trauma surgery identified by CPT codesOutcome Measures and Comparisons: The primary outcomes were the risk-adjusted relationship between amount of industry payments to surgeons and the total and operating costs. The secondary outcomes were the risk-adjusted relationships between amount of industry payments to surgeons and hospital length of stay, mortality, and readmission.

Results: 99.9% of orthopaedic trauma surgeons (n=9,023) received industry payments. Median patient age was 82 (IQR: 15), 73.2% female, 91.5% White, and with multiple comorbidities (CCI median [IQR] 6 [4]). After multivariable risk adjustment, for each $1,000 increase in surgeon industry payments, total and operating room cost of cases increased by $2.25 and $1.26 (0.003% and 0.008% of total cost), respectively (p<0.001). The median industry payment was $607.72 compared to the mean of $12,070.84 indicating a highly right-skewed distribution of payments. Amount of industry payments were not associated with length of stay (p=0.18), 30-day mortality (p=0.094) or readmission (p=0.59) after orthopaedic trauma surgery. Total and operating room cost was approximately $8,920 (17.8%) and $1,481 (14.2%) higher for surgeons receiving the highest 5% of industry payments (p<0.001). These surgeons generally practiced in large urban areas (51.7%; p<0.001), in hospitals with higher number of beds (median 398; p<0.001), with higher wage index (0.96; p<0.001).

Conclusions: and Relevance: While most orthopaedic trauma surgeons received industry payments, a minority of surgeons received the majority of payments. Although industry payments may lead to conflicts for some surgeons, these conflicts affect only a small proportion of the cost of fracture care.

Level of evidence: Prognostic Level III.