Evaluation of Surgical Costs in Acute Achilles Repairs

Abstract

Introduction/Purpose: Increasing attention is being paid to the costs associated with various orthopedic surgeries. Here, we studied the factors that influence costs associated with surgically treated acute Achilles tendon tears. Methods: We retrospectively identified patients with surgically repaired acute Achilles tendon tears, excluding insertional ruptures or chronic tendon issues. Using the Value Driven Outcome (VDO) tool from our institution, we assessed total direct costs as well as facility costs. Briefly, the VDO tool includes an item-level database that can capture granular-level cost data – costs are then reported as relative mean data. Cost variables were adjusted to 2022 US dollars, and total direct cost was compared with patient characteristics using gamma regressions to report cost ratios with 95% confidence intervals (CIs). Results: Our cohort consisted of 224 patients with Achilles tendon tears surgically repaired by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographics, total direct costs, or facility costs based on positioning (prone N =156, supine N =68). Total direct costs were 9% higher in males (N =182) compared to females (N =42) (p=0.023, 95% CI: 1.01-1.17) in an unadjusted analysis. Mini-open repairs (N =215), compared to percutaneous techniques (N =9), had 32% less total direct costs (p < 0.001; 95% CI: 0.60-0.78). Compared to surgery at a main academic hospital (N =15), procedures at an ambulatory care center (N =207) had 25% lower total direct costs (p < 0.001; 95% CI: 0.67-0.83) and 44% lower reduced facility costs (p < 0.001; 95% CI: 0.51-0.61). Significance was maintained in multivariable analysis except for sex. Conclusion: Improving cost-effective orthopedic care remains an increasingly important goal. Patient positioning for Achilles tendon repair does not appear to have meaningful effects on cost. Surgery at an ambulatory center was significantly less costly than repairs performed at an academic hospital. When clinically appropriate, considering surgery location at an ambulatory center appears to reduce surgical costs.