社会经济差异和程序复杂性影响初级髌骨不稳治疗费用：一项全国性分析

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-08-01 DOI:10.1016/j.asmr.2025.101197

Timothy A. Reiad B.S. , Peter V. Dinh B.S. , David Bruni M.D. , John Milner M.D. , Brett D. Owens M.D. , Stephen E. Marcaccio M.D.

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引用次数: 0

摘要

目的调查与髌骨不稳主要治疗方案收费相关的因素，分析实施特定伴随手术的财务影响，并确定与髌骨不稳治疗相关的医疗保健收费的关键社会决定因素。方法本回顾性研究使用2019年全国门诊手术样本，对接受单一稳定手术及相关伴随手术的原发性髌骨不稳患者进行分析。有多个主要稳定程序的病例或有不相关的现行程序术语代码的病例被排除在外。双变量分析确定了重要的协变量，这些协变量包括在广义线性模型中，以比较当前程序术语代码中的收费，并根据患者和医院因素进行调整。结果共分析3035例手术，其中关节镜下外侧支持带松解术54.79%，开放外侧松解术7.45%，髌股内侧韧带（MPFL）重建术31.73%，胫骨结节截骨术6.03%。平均而言，胫骨结节截骨术（47,401美元）的费用高于MPFL重建（41,333美元）、关节镜下外侧松解术（23,930美元）和开放外侧松解术（34,520美元）。收费因患者人口统计和医院特点而异。与白人患者相比，非白人患者面临更高的费用（36051美元对29924美元，P < .001）。同样，西班牙裔患者面临的费用高于非西班牙裔患者（38,256美元对30,861美元，P < .001）。男性患者的收费高于女性患者（P < .001）。私立医院比公立医院多收费10,422美元（P < .001）。城市医院比农村医院多收费3 929美元。骨软骨移植费用增加了35,816美元（P < 0.001）。结论：本研究强调了髌骨不稳治疗收费的显著差异，受手术复杂性、伴随干预和人口因素的影响。胫骨结节截骨是最昂贵的治疗选择，其次是MPFL重建。伴随骨软骨移植明显增加电荷。根据患者人口统计数据和医院特征，收费差异很明显，非白人种族、西班牙裔以及在私立医院或城市医院进行的手术相关的收费较高。了解髌骨不稳治疗的成本驱动因素可以为临床决策、资源分配和解决骨科和运动医学护理中的医疗保健差异提供信息。

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Socioeconomic Disparities and Procedural Complexity Influence Charges in Primary Patellar Instability Treatment: A Nationwide Analysis

Purpose

To investigate the factors associated with charges of primary treatment options for patellar instability, analyze the financial impact of performing specific concomitant procedures, and identify critical social determinants of health care charges associated with patellar instability treatment.

Methods

This retrospective study used the 2019 Nationwide Ambulatory Surgery Sample to analyze patients with primary patellar instability undergoing a single stabilization procedure, including relevant concomitant procedures. Cases with multiple primary stabilization procedures or cases with unrelated concomitant Current Procedural Terminology codes were excluded. Bivariate analyses identified significant covariates, which were included in a generalized linear model to compare charges across Current Procedural Terminology codes, adjusting for patient and hospital factors.

Results

In total, 3,035 procedures were analyzed, including 54.79% arthroscopic lateral retinacular releases, 7.45% open lateral releases, 31.73% medial patellofemoral ligament (MPFL) reconstructions, and 6.03% tibial tubercle osteotomies. On average, tibial tubercle osteotomy ($47,401) had greater charges than MPFL reconstruction ($41,333), arthroscopic lateral release ($23,930), and open lateral release ($34,520). Charges varied by patient demographics and hospital characteristics. Non-White patients faced greater charges compared with White patients ($36,051 vs $29,924, P < .001). Similarly, Hispanic patients faced greater charges than non-Hispanic patients ($38,256 vs $30,861, P < .001). Male patients were charged more than female patients (P < .001). Private hospitals charged $10,422 more than public hospitals (P < .001). Urban hospitals charged $3,929 more than hospitals in rural locations. Osteochondral grafting increased charges by $35,816 (P < .001).

Conclusions

This study highlights significant variability in charges for patellar instability treatments, influenced by procedural complexity, concomitant interventions, and demographic factors. Tibial tubercle osteotomy was the most expensive treatment option, followed by MPFL reconstruction. Concomitant osteochondral grafting significantly increased charges. Disparities in charges were evident on the basis of patient demographics and hospital characteristics, with greater charges associated with non-White race, Hispanic ethnicity, and procedures performed in private hospitals or urban hospitals.

Clinical Relevance

Understanding cost drivers in patellar instability treatment can inform clinical decision-making, resource allocation, and efforts to address health care disparities in orthopedic and sports medicine care.

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