Industry Payments to Orthopaedic Surgeons: A Geospatial Analysis of the Open Payments Database.

Introduction: There has been an increasing demand for transparency between industry and physicians. Several studies have evaluated the distribution of payment value and types to orthopaedic surgeons, but little is known about the spending patterns from an industry-centric perspective. The purpose of this study was to describe the payment patterns of top medical device companies in orthopaedics while presenting a geospatial analysis of these trends.

Methods: The Open Payments database was assessed for all records of industry financial relationships with orthopaedic surgeons from 2015 to 2021. Value of financial relationships was expressed on a per orthopaedic surgeon basis, with the numerator representing total value of payments and denominator representing number of orthopaedic surgeons, and was geographically analyzed according to United States Census Divisions.

Results: Based on averages during the study period, the top 10 paying companies were (1) DePuy, (2) Zimmer Biomet, (3) Stryker Corporation, (4) Arthrex, (5) SpineFrontier, (6) Medtronic, (7) Smith and Nephew, (8) Renovis Surgical Technologies, (9) NuVasive, and (10) Paragon 28. Payments in the South Atlantic ($6,854 ± $1,265) Division were significantly greater than all other eight divisions ( P < 0.001), with the next leading division being the Pacific Division ($4,114 ± $643). Five companies strongly favored one particular division, directing more than double the amount of payments to this division compared with the next leading division (SpineFrontier, 99% South Atlantic; Renovis Surgical Technologies, 81% Pacific; Paragon 28, 59% South Atlantic; NuVasive, 43% West North Central; DePuy, 35% South Atlantic). Only 3 of 10 companies were headquartered in the same division where most payments were made.

Conclusion: From 2015 to 2021, companies preferentially supported surgeons in certain geographic regions, irrespective of where they were headquartered in. Surgeons in the South Atlantic Division received significantly more payments than any other division by a wide margin.