Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis
Background: Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-01-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/24730114231224727 |
| _version_ | 1797338649118900224 |
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| author | Arinze Ochuba BS Christopher J. Murdock MD Amy L. Xu BS Morgan Snow BA Jessica Schmerler BS Christopher R. Leland MD Claire McDaniel MD John Thompson MD Amiethab A. Aiyer MD |
| author_facet | Arinze Ochuba BS Christopher J. Murdock MD Amy L. Xu BS Morgan Snow BA Jessica Schmerler BS Christopher R. Leland MD Claire McDaniel MD John Thompson MD Amiethab A. Aiyer MD |
| author_sort | Arinze Ochuba BS |
| collection | DOAJ |
| description | Background: Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the cost difference between ORIF and PA of Lisfranc injuries, along with the contribution of medical services to overall costs. Methods: This was a retrospective cost analysis of the MarketScan database from 2010 to 2020. MarketScan is an insurance and commercial claims database that integrates deidentified patient information. It captures person-specific clinical utilization, expenditures, and enrollment across inpatient and outpatient services. Patients undergoing primary ORIF ( CPT code 28615) vs PA (28730 and 28740) for Lisfranc fracture-dislocation were identified. The primary independent variable was ORIF vs PA of Lisfranc injury. Total costs due to operative management was the primary objective. The utilization of and costs contributed by medical services was a secondary outcome. Results: From 2010 to 2020, a total of 7268 patients underwent operative management of Lisfranc injuries, with 5689 (78.3%) ORIF and 1579 (21.7%) PA. PA was independently associated with increased net and total payment and coinsurance, clinic visits, and imaging, and patients attended significantly more PT sessions. Conclusion: Using this large database that does not characterize severity or extent of injury, we found that treatment of Lisfranc fracture-dislocation with ORIF was associated with substantially lower initial episode of treatment costs compared with PA. Specific excessive cost drivers for PA were clinic visits, PT sessions, and imaging. Level of Evidence: Level III, retrospective cohort study. |
| first_indexed | 2024-03-08T09:34:21Z |
| format | Article |
| id | doaj.art-daf77b41d4df439fb93d3df3c6032b5f |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-03-08T09:34:21Z |
| publishDate | 2024-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-daf77b41d4df439fb93d3df3c6032b5f2024-01-30T16:04:12ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-01-01910.1177/24730114231224727Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost AnalysisArinze Ochuba BS0Christopher J. Murdock MD1Amy L. Xu BS2Morgan Snow BA3Jessica Schmerler BS4Christopher R. Leland MD5Claire McDaniel MD6John Thompson MD7Amiethab A. Aiyer MD8Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USAOrthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USAOrthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USAOrthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USAOrthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USAMassachusetts General Hospital/Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USAOrthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USAOrthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USAOrthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USABackground: Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the cost difference between ORIF and PA of Lisfranc injuries, along with the contribution of medical services to overall costs. Methods: This was a retrospective cost analysis of the MarketScan database from 2010 to 2020. MarketScan is an insurance and commercial claims database that integrates deidentified patient information. It captures person-specific clinical utilization, expenditures, and enrollment across inpatient and outpatient services. Patients undergoing primary ORIF ( CPT code 28615) vs PA (28730 and 28740) for Lisfranc fracture-dislocation were identified. The primary independent variable was ORIF vs PA of Lisfranc injury. Total costs due to operative management was the primary objective. The utilization of and costs contributed by medical services was a secondary outcome. Results: From 2010 to 2020, a total of 7268 patients underwent operative management of Lisfranc injuries, with 5689 (78.3%) ORIF and 1579 (21.7%) PA. PA was independently associated with increased net and total payment and coinsurance, clinic visits, and imaging, and patients attended significantly more PT sessions. Conclusion: Using this large database that does not characterize severity or extent of injury, we found that treatment of Lisfranc fracture-dislocation with ORIF was associated with substantially lower initial episode of treatment costs compared with PA. Specific excessive cost drivers for PA were clinic visits, PT sessions, and imaging. Level of Evidence: Level III, retrospective cohort study.https://doi.org/10.1177/24730114231224727 |
| spellingShingle | Arinze Ochuba BS Christopher J. Murdock MD Amy L. Xu BS Morgan Snow BA Jessica Schmerler BS Christopher R. Leland MD Claire McDaniel MD John Thompson MD Amiethab A. Aiyer MD Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis Foot & Ankle Orthopaedics |
| title | Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis |
| title_full | Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis |
| title_fullStr | Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis |
| title_full_unstemmed | Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis |
| title_short | Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis |
| title_sort | open reduction internal fixation vs primary arthrodesis for lisfranc fracture dislocations a cost analysis |
| url | https://doi.org/10.1177/24730114231224727 |
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