Kade Wagers

Background: There is growing focus on surgical costs related to common orthopedic 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 CPT codes from 2014 to 2020. Utilizing 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 demographics variables was performed using generalized linear models to yield cost ratios along with 95% confidence intervals (CIs).

Results: Our cohort consisted of 263 patients who underwent primary ankle fusion procedures done by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in total OR time based on surgical construct (screws-alone N=229 versus anterior plate-screws N=34). Total direct costs for anterior plate-screw constructs were 72% higher than screws alone (ratio in cost =1.72, 95% CI 1.49~2.03, p<0.001).

Conclusion: Our investigation found that anterior plate-screw constructs for tibiotalar arthrodesis have notably higher total costs compared to 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.