Evaluation of surgical costs associated with isolated distal fibula fractures.

Abstract

Background: Operative fixation of distal fibula fractures is a common surgical procedure within orthopaedics. Understanding the variables that influence cost for surgical management of such injuries is increasingly important. In this study, we aimed to evaluate the cost differences in isolated distal fibula fixation.

Methods: In total, 394 patients were identified who underwent isolated distal fibula fracture fixation between 2018 and 2025 based on Current Procedural Terminology (CPT) coding (27792). Patient demographics, fixation strategy, implant type, and surgical setting were analyzed. Multivariable generalized linear models with inverse Gaussian distribution were used to estimate adjusted cost ratios. Cost data were obtained using the Value-Drive Outcomes (VDO) tool, an instrument at our institution that aggregates itemized costs for each surgical encounter. Costs are reported as relative cost ratios rather than raw dollar amounts.

Results: Of the 394 surgeries, 244 were performed at a specialty surgery center (SSC) and 150 were completed at an academic medical center (AMC). Total direct costs were higher for fibula fracture surgery performed at an AMC vs an SSC, resulting in a 42% increase in total direct costs for AMC procedures (cost ratio 1.42, 95% CI 1.32-1.52). Further, AMC facility costs were 84% higher than SSC (cost ratio 1.84; 95% CI 1.75-1.94), with the difference driven primarily by non-OR facility costs whereas OR facility costs were comparable between sites. Implant choice for fibula fixation did not appear to meaningfully influence cost. Surgeon specialty type did not differ in facility cost after controlling for surgery setting (facility cost ratio 1.00, 95% CI 0.95-1.06; P = .97).

Conclusion: Distal fibular fracture fixation is significantly more costly when performed at an academic medical center than at a specialty surgery center, largely due to differences in non-OR facility costs. When medically appropriate, operative management of fibula fractures in an outpatient setting may lead to significant cost reductions.

Level of evidence: Level III, retrospective comparative study.