Study of Surgical Costs Associated With Tibiotalar Fusion.

Background: There is growing focus on surgical costs related to common orthopaedic procedures. In this investigation, we studied surgical costs associated with tibiotalar arthrodesis.

Methods: Patients were retrospectively identified who had undergone primary fusion of the tibiotalar joint based on Current Procedural Terminology (CPT) codes from 2014 to 2020. Using the Value Driven Outcome (VDO) tool, we conducted an evaluation of both total direct costs and facility-related expenses. The VDO tool encompasses a comprehensive item-level database capable of capturing detailed cost information, which is subsequently presented as relative mean data. Adjustments were made to cost variables to reflect 2022 US dollars, and comparative multivariable analysis of costs in relation to treatment groups adjusting for demographic variables was performed using generalized linear models to yield cost ratios along with 95% CIs.

Results: Our cohort consisted of 262 patients who underwent primary ankle fusion procedures done by one of 4 fellowship-trained orthopaedic foot and ankle surgeons. There were no differences in demographic data or total operating room (OR) time based on surgical construct (screws-alone n = 228 vs anterior plate-screws n = 34). Total direct costs for anterior plate-screw constructs were 78% higher than screws alone (ratio in cost = 1.78, 95% CI 1.55-2.08, P < .001), adjusting for other variables. For all fusion constructs, every 1-hour increase in total OR time increased total direct costs by 29% (ratio in cost = 1.29, 95% CI 1.18-1.40, P < .001).

Conclusion: Enhancing cost-effectiveness of orthopaedic care remains an important objective. Our investigation found that anterior plate-screw constructs for tibiotalar arthrodesis have notably higher total costs compared with screw-only constructs. Many variables are considered when selecting surgical constructs for ankle arthrodesis. When clinically appropriate, screw-only ankle arthrodesis constructs could be considered if there is a need to reduce costs.

Level of evidence: Level III, retrospective comparative study.