High Case Volume Predicts Greater Odds of Autograft Use and Meniscal Repair for Anterior Cruciate Ligament Reconstruction
| Autor: | Paul D. Fadale, Shayna R. Mehta, Lambert T. Li, Brett D. Owens, Steven L. Bokshan, Steven F. DeFroda |
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| Rok vydání: | 2020 |
| Předmět: |
030222 orthopedics
Univariate analysis medicine.medical_specialty Multivariate analysis Anterior cruciate ligament reconstruction business.industry medicine.medical_treatment Retrospective cohort study 030229 sport sciences Odds Surgery 03 medical and health sciences surgical procedures operative 0302 clinical medicine Concomitant Ambulatory Current Procedural Terminology Medicine Orthopedics and Sports Medicine business |
| Zdroj: | Arthroscopy: The Journal of Arthroscopic & Related Surgery. |
| ISSN: | 0749-8063 |
| DOI: | 10.1016/j.arthro.2020.08.011 |
| Popis: | To evaluate how both annual surgeon and facility volume affect the cost and outcomes of anterior cruciate ligament reconstruction surgery. We also aimed to identify trends in how surgeon caseload predicts graft selection.The 2014 State Ambulatory and Surgical Database from Florida was used. Every case with Current Procedural Terminology code 29888 ("Arthroscopic anterior cruciate ligament reconstruction") was selected. Surgeon and facility identifiers were used to separate high- and low-volume groups, defined as25 cases for surgeons and125 cases for facilities. Univariate analysis was performed for patient demographics and surgical characteristics. Multivariate analysis was performed on significant factors to determine how these variables impact cost and odds of allograft usage, postoperative admission, and meniscal repair.There were 7905 cases performed between January 1, 2014, and December 31, 2014 after excluding same-year revisions. High-volume surgeons had $6155 lower total charges, were 1.949 times more likely to use an autograft, and had 54.5% lower odds of postoperative admission (all P.001). They were also 1.196 times more likely to perform a meniscal repair (P = .017). In patients younger than 18, low-volume surgeons were 3.7 times more likely to use an allograft (P.001). Concomitant multiligamentous procedures were also performed at greater rates in the high-volume group. Postoperative admission added $18,698, and allografts added $9174 (both P.001).We found that high-volume surgeons were more likely to perform a meniscal repair and less likely to have their patients admitted postoperatively, which was the second largest cost driver of anterior cruciate ligament reconstruction. They were also significantly less likely to use an allograft, especially in patients younger than the age of 18 years. High-volume surgeons had lower costs despite greater rates of concomitant procedures.III, retrospective cohort study. |
| Databáze: | OpenAIRE |
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