Cost Comparison of Digital Nerve Repair Techniques.

Background: Direct cost comparisons of nerve allograft with other techniques for repairing short digital nerve gaps are lacking. This study compares the costs of various techniques for digital nerve repair, anticipating significant cost increases for allograft implants.

Methods: The State Ambulatory Surgery and Services Databases for Florida, New York, and Wisconsin from 2015 through 2020 were used. Patients with primary repair, short autograft, conduit, and allograft were compared along total, surgical supply, operating room, and anesthesia charges.

Results: Among 5009 patients, there were 2967 primary nerve repairs (59.2%), 77 autografts (1.5%), 1647 conduits (32.9%), and 318 allografts (6.3%). A total of 2886 patients were male (57.6%), and the mean patient age was 40.4 ± 16.3 years. Over the study period, primary repairs decreased (from 63.9% in 2015 to 56.3% in 2020), whereas allografts increased significantly (from 8.8% in 2018 to 12.6% in 2020). Median total charges varied significantly across procedures, with the most expensive being allograft ($35,295), followed by conduit ($25,717), autograft ($24,749), and primary repair ($18,767). On multivariable regression, allografts were significantly more expensive than autografts in total charges of $11,224 (95% CI, $4196 to $18,252) and supply charges of $10,484 (95% CI, $6073 to $14,896), but not in operating room or anesthesia charges. Flexor tendon repair was associated with greater total, operating room, and anesthesia charges, but had similar supply charges.

Conclusions: Nerve allografting is the most expensive digital nerve repair technique, most likely due to the cost of the implant. To minimize health care expenditure and ensure equitable patient access, surgeons should consider this cost along with clinical factors when choosing digital nerve repair techniques.