Increased Surgical Costs Do Not Result in Improved Patient-Reported Outcomes: A Study of 173 Patients Who Underwent Thumb Carpometacarpal Joint Arthroplasty.

Abstract

Background: The purpose of this study is to evaluate the relationship of surgical cost and patient-reported outcomes (PROs) in thumb carpometacarpal (CMC) arthroplasty. We hypothesize that increasing costs are not positively correlated with PROs. Methods: A prospectively collected PRO registry was retrospectively reviewed for patients who underwent surgery for CMC arthritis treatment. A total of 288 patients in a single health care system were identified with a completed Patient-Rated Wrist and Hand Evaluation (PRWHE) survey at all timepoints. Patients were excluded based on nonoperative treatment, revision, concomitant procedures, and if they lacked PRWHE scores at any timepoint. A total of 173 patients met criteria. Time-driven activity-based costing was used to calculate day-of-surgery (DOS) costs. Results: The most common CMC arthroplasty technique used suture suspensionplasty (n = 142, 82.1%). The average surgical cost was $2830.36 ± $619.41. The average PRWHE scores preoperatively, at 6 weeks, 3 months, and 6 months were 62.1 ± 18.4, 44.9 ± 19.2, 31.5 ± 18.4, and 18.0 ± 17.1, respectively. There were no statistically significant correlations between cost and PROs at 6 weeks, 3 months, or 6 months (r = -0.02, r = -0.03, r = 0.04, respectively). There were no statistically significant correlations between total cost and the change in PRWHE scores from baseline to 6 weeks, baseline to 3 months, or baseline to 6 months (r = 0.09, r = 0.10, r = 0.15, respectively). Conclusions: This study demonstrates that when surgical management is pursued in CMC arthritis, patients do not receive additional benefit with higher DOS costs. Surgeons should implement strategies to minimize variability and drive the value of care within their institution.