How Much Does Acl Repair Surgery Cost
Orthop J Sports Med. 2022 Jan; five(1): 2325967116684776.
Toll of Outpatient Arthroscopic Inductive Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United states of america, 2005-2013
Mackenzie M. Herzog
†Department of Epidemiology, Gillings School of Global Public Wellness, University of North Carolina at Chapel Hill, Chapel Loma, North Carolina, U.s.a..
‡University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, United states.
Stephen West. Marshall
†Department of Epidemiology, Gillings Schoolhouse of Global Public Wellness, Academy of North Carolina at Chapel Loma, Chapel Hill, North Carolina, U.s..
‡Academy of N Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, U.s.a..
§Department of Practice and Sport Scientific discipline, College of Arts and Sciences, Academy of Due north Carolina at Chapel Colina, Chapel Loma, North Carolina, Usa.
Jennifer L. Lund
†Department of Epidemiology, Gillings School of Global Public Health, Academy of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Virginia Pate
†Department of Epidemiology, Gillings Schoolhouse of Global Public Health, University of North Carolina at Chapel Hill, Chapel Colina, North Carolina, USA.
Jeffrey T. Spang
ǁDepartment of Orthopaedics, School of Medicine, Academy of North Carolina at Chapel Colina, Chapel Loma, North Carolina, United states of america.
Abstract
Background:
Despite the significance of anterior cruciate ligament (ACL) injuries, these conditions accept been nether-researched from a population-level perspective. It is important to determine the economical effect of these injuries in order to certificate the public wellness burden in the United States.
Purpose:
To describe the cost of outpatient arthroscopic ACL reconstruction and health care utilization among commercially insured beneficiaries in the United states of america.
Report Design:
Economic and decision assay; Level of evidence, 3.
Methods:
The study used the Truven Health Analytics MarketScan Commercial Claims and Encounters database, an administrative claims database that contains a large sample (approximately 148 million) of privately insured individuals aged <65 years and enrolled in employer-sponsored plans. All claims with Current Procedural Terminology (CPT) code 29888 (arthroscopically aided ACL reconstruction or augmentation) from 2005 to 2022 were included. "Immediate procedure" cost was computed assuming a three-day window of care centered on date of surgery. "Total health care utilization" price was computed using a 9-month window of care (3 months preoperative and 6 months postoperative).
Results:
There were 229,446 outpatient arthroscopic ACL reconstructions performed over the 9-year study flow. Median firsthand procedure cost was $9399.49. Median total wellness care utilization cost was $13,403.38. Patients who underwent concomitant collateral ligament (medial [MCL], lateral [LCL]) repair or reconstruction had the highest costs for both immediate procedure ($12,473.24) and health care utilization ($17,006.34). For patients who had more than than ane reconstruction captured in the database, total health care utilization costs were higher for the second procedure than the first procedure ($16,238.43 vs $15,000.36), despite the fact that immediate procedure costs were lower for 2nd procedures ($8685.73 vs $9445.26).
Decision:
These results provide a foundation for agreement the public health burden of ACL injuries in the Us. Our findings suggest that further inquiry on the prevention and treatment of ACL injuries is necessary to reduce this brunt.
Keywords: inductive cruciate ligament, ACL reconstruction, cost, claims data
Musculoskeletal conditions affect up to 1.7 billion people worldwide and contribute to approximately 166 million years lived with disability (YLDs), which was an increment of 44.seven% from 1990.22,23 Roughly i in 7 people in the United States report musculoskeletal weather.5 Anterior cruciate ligament (ACL) ruptures are one of the most mutual,11 and the incidence of these injuries among younger historic period groups, in particular, is high and has increased in contempo years.4,13,14
Despite the significance of ACL and other musculoskeletal injuries, these conditions take been under-researched from a population-level perspective.3,10 Jacobs et al10 reported that musculoskeletal research represented only <2% of the National Institutes of Wellness (NIH) budget in 2022. The United States Os and Joint Initiative also produced "The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Costs, 3rd edition," which advocates for research that provides back up for futurity investment in musculoskeletal conditions.twenty Furthermore, the United states Centers for Affliction Control and Prevention (CDC) highlighted the importance of determining the economical costs of sports injuries, such every bit ACL injury, to document the public health brunt of these conditions in the United states of america in the 2009-2018 CDC Injury Research Agenda.nine
Because of the debilitating nature of ACL tears, many people with ACL disruption undergo surgical intervention to reconstruct the ligament and stabilize the knee.11,15,24 The incidence of ACL reconstruction has increased steadily over the past decade, which may exist due to an increase in injuries and/or increased recognition of benefits of reconstruction.fourteen,xv Apart from the costs of surgery, patients face a long form of rehabilitation after reconstruction, typically for approximately 6 months, along with other associated wellness intendance utilization.11,17 Surprisingly, express information is available in the literature on the surgery-specific costs and other wellness care utilization related to treatment of these injuries.
Large, administrative health care databases provide a unique opportunity to quantify the economic effect of musculoskeletal injuries. Compared with infirmary- or health care system–specific cost estimates, these data sources tin provide of import data regarding cost to the health care organization with a wide, population perspective. The purpose of this study was to provide a electric current description of cost of ACL reconstruction by detailing costs of outpatient arthroscopic ACL reconstruction and associated health care utilization among commercially insured individuals <65 years of age in the U.s.. We hypothesize that the results of this written report will highlight the price burden of these injuries and illustrate the population effect of these injuries.
Methods
Report Population
This descriptive cost assay of outpatient arthroscopic ACL reconstruction in the Us was conducted using the Truven Wellness Analytics MarketScan Commercial Claims and Encounters database from 2005 to 2022. The Truven Health Analytics MarketScan Commercial Claims and Encounters database is an administrative database that contains claims data related to insurance enrollment, clinical utilization, and health care expenses for a big sample of privately insured patients.vi Patients included in this database are insured through approximately 100 payers from employer-sponsored plans and include active employees, early retirees, Consolidated Omnibus Budget Reconciliation Human activity (COBRA) beneficiaries, and dependents.6 All patients included in the database are <65 years one-time. To date, there are more than 20 billion claims for approximately 148 million unique individuals included in the database, and individuals in the database can be followed for the duration of their insurance coverage.6
Inclusion Criteria
Patients were identified using dr. claims from the Outpatient Services file, and ACL reconstruction was identified using Electric current Procedural Terminology (CPT) codes. The inclusion criterion was CPT lawmaking 29888 for arthroscopically aided ACL reconstruction or augmentation betwixt January one, 2005, and December 31, 2022. Both main and revision ACL reconstruction procedures were included. Inpatient ACL reconstruction and open up ACL reconstruction (CPT 27428) were non included in the sample because the bulk of ACL reconstructions performed over this time menstruum were outpatient, arthroscopic reconstructions.2,xiv Outpatient procedures were abstracted from the "Outpatient Services Table" of the database, which includes services performed in a hospital outpatient facility or other outpatient facility such equally an ambulatory surgical center.6 In improver, services that were performed in a hospital setting just did non result in admission to the hospital were included.6 All patients who met these criteria were included in the analysis of the "immediate procedure" costs.
For the analysis of "overall health intendance utilization" costs related to the reconstruction, in that location were additional exclusion criteria. In society to determine cost, patients were required to have a period of continuous enrollment in the database for three months prior to the surgical procedure and half-dozen months after the surgical process. Continuous enrollment was necessary to ensure that health care utilization was captured in the database and cost could exist correctly estimated for a utilization period. A grace period including a maximum eight-day lapse in coverage was used for continuous enrollment identification. Patients who were not continuously enrolled in the database for the 9-month utilization menses were excluded from the analysis of overall health care utilization costs but were included in immediate procedure toll analysis.
Cost Analysis
Immediate Procedure Price
For the purposes of identifying the immediate procedure toll, including associated costs for the facility, physician, anesthesia, and other care, all codes billed for a 3-day window surrounding the day of the process were identified (day of procedure ± ane day). The iii-mean solar day window was used considering some procedural costs might be billed on days adjacent to the day of surgery. The price of all codes billed during the three-solar day period were summed by individual beneficiary and date of surgery. Total cost was calculated using the variable for gross payments to a provider for a service. This variable indicates the total eligible payment under the terms of the medical plan prior to applying coordination of benefits, copayment, coinsurance, or deductible.6
Total Health Intendance Utilization Costs
To compute total wellness care utilization costs related to the surgical procedure, claims from a 9-month time window comprising 3 months preoperative through 6 months postoperative were considered. This period was chosen based on clinical experience and previous literature on typical preoperative and postoperative duration of intendance related to an ACL reconstruction.7,12 We included all claims billed for the patient during the 9-calendar month window of care that included any knee joint-related diagnosis code or a CPT lawmaking of 29888, where a knee-related diagnosis code was defined as International Nomenclature of Diseases, 9th revision (ICD-9) diagnosis codes 717.Xx, 836.XX, 844.10, 959.7, 719.Ten, 719.X0, 719.X6, 719.X8, and 719.X9 (except ICD-9 719.3X). This method is hereafter referred to equally "any genu-related diagnosis in a 9-month window." The working assumptions of this method are that (1) all care is completed within the 3-month preoperative and half dozen-month postoperative window, (two) all intendance pertaining to the reconstruction receives one of the knee-related diagnosis codes listed higher up, and (3) all treat knee diagnosis during this nine-calendar month window pertains to the index ACL reconstruction. Nosotros examined the robustness of our toll estimates to these assumptions past comparing the results with those obtained under two alternating methods. The first alternative method implemented a "lower bound" conservative approach by using diagnosis codes billed with the 29888 CPT for the patient during the 9-month period. The 2nd alternative method represented an "upper bound" liberal approach by just including all claims during the 9-calendar month window, irrespective of diagnosis.
In improver, because the immediate procedure costs are included in the full wellness intendance utilization costs, we computed the departure betwixt the costs. This calculation allows for better cess of whether sure procedures are more than or less costly during the perioperative period.
Concomitant and Multiple Injuries
To compare costs associated with isolated ACL reconstruction to costs associated with ACL reconstruction performed with other procedures, the post-obit concomitant procedures were identified: medial and/or lateral meniscectomy (CPT: 29880, 29881, 27332), medial and/or lateral meniscal repair (CPT: 29882, 29883, 27403), chondroplasty (CPT: 29877), microfracture (CPT: 29879), collateral ligament (MCL, LCL) repair or reconstruction (CPT: 27405, 27409, 27427), and posterior cruciate ligament (PCL) repair or reconstruction (CPT: 29889). Total toll for patients who underwent isolated ACL reconstruction were compared with costs for patients who underwent these concomitant procedures for both immediate procedure and total health care utilization costs.
Finally, in society to appraise the cost difference for reconstruction between patients who have 1 ACL injury versus patients who have bilateral or revision ACL injuries, first and subsequent ACL reconstructions were identified in the database. The first ACL reconstruction identified in the database per patient was considered the index reconstruction. Any ACL reconstruction captured in the database afterward the index procedure per patient was considered a subsequent ACL reconstruction, which could either represent a revision ACL reconstruction or an ACL reconstruction of the contralateral knee.
Statistical Assay
Descriptive statistics, including mean, median, and range, were calculated for all cost variables. Costs were also adjusted to 2022 values to business relationship for inflation over the time period. Each annual toll was calculated in 2022 dollars using U.s.a. Regime Consumer Product Index (CPI) data.21 Comparative cost analyses were non performed to assess statistical significance of results or cost-effectiveness of procedures.
Results
There were 229,446 unique outpatient arthroscopic ACL reconstructions performed between January 1, 2005, and Dec 31, 2022. More males (57%) underwent ACL reconstruction than females (43%) (Table i). The hateful patient age at the time of arthroscopy was 29 years, with 25% younger than eighteen years and 25% older than 39 years. Lx-five pct of ACL reconstructions had concomitant procedures, with a hateful 0.82 ± 0.72 concomitant procedures performed in addition to the ACL reconstruction overall.
TABLE 1
Demographic Information for Patients Who Underwent Outpatient Arthroscopic ACL Reconstruction Identified in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, 2005-2013 a
| Total Population (N = 229,446) | Included in ix-Month Menstruation (N = 159,201) | |||
|---|---|---|---|---|
| n | % | n | % | |
| Sex | ||||
| Male | 130,284 | 57 | 89,282 | 56 |
| Female | 97,857 | 43 | 27,938 | 44 |
| Missing | 1305 | |||
| Region | ||||
| Northeast | 31,558 | 14 | 21,213 | 13 |
| North Central | 54,604 | 24 | 38,658 | 24 |
| South | 91,577 | forty | 63,688 | 40 |
| West | 48,642 | 21 | 33,847 | 21 |
| Unknown | 3065 | 1795 | ||
| Concomitant procedures b | ||||
| Meniscectomy | 115,947 | 51 | eighty,859 | 50 |
| Meniscal repair | 37,927 | 17 | 26,086 | 16 |
| Chondroplasty | 17,606 | 8 | 12,714 | eight |
| Microfracture | eleven,646 | v | 8082 | v |
| Collateral ligament (MCL, LCL) | 4021 | 2 | 2713 | 2 |
| PCL | 1831 | 0.eight | 1242 | 0.8 |
The total firsthand process cost for the 229,446 ACL surgeries identified in the database was $2,622,928,663.00 for ACL reconstructions occurring betwixt 2005 and 2022. The mean immediate procedure toll was $xi,431.57, and the median was $9399.49 (Tabular array 2). The median immediate procedure cost for ACL surgery increased over the study menses from $7634.19 in 2005 to $x,780.03 in 2022 (Figure 1). When adjusted to 2022 value, an increment in price over the study menses was even so appreciated (Figure 1). The total toll median was lowest among patients who underwent isolated ACL reconstruction, whereas patients who underwent concomitant collateral ligament (MCL, LCL) repair or reconstruction had the highest total price for the immediate procedure.
TABLE ii
Firsthand Process Toll for Outpatient Arthroscopic ACL Reconstruction Among Patients Included in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, 2005-2013 (Northward = 229,446) a
| Procedure | Due north | Mean, $ | Median, $ | 25th Percentile, $ | 75th Percentile, $ |
|---|---|---|---|---|---|
| All ACL | 229,446 | 11,431.57 | 9399.49 | 6491.36 | 14,157.30 |
| ACL but | 78,676 | 10,144.91 | 8276.88 | 5648.44 | 12,692.43 |
| ACL + meniscectomy | 115,947 | 11,987.17 | 9945.01 | 7011.33 | 14,689.55 |
| ACL + meniscal repair | 37,927 | xiii,134.13 | x,853.55 | 7613.02 | 16,211.42 |
| ACL + chondroplasty | 17,606 | 11,677.91 | 9520.17 | 6685.71 | 14,201.22 |
| ACL + microfracture | 11,646 | 13,027.sixteen | x,599.threescore | 7338.eighteen | 15,848.79 |
| ACL + collateral ligament | 4021 | 15,338.88 | 12,473.24 | 7952.15 | 19,385.88 |
| ACL + PCL | 1831 | xv,666.83 | xi,776.85 | 6984.00 | 20,193.37 |
Almanac trends for median immediate process price for outpatient arthroscopic anterior cruciate ligament reconstruction among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database, 2005-2013 (Northward = 229,446).
Of the patients who met the initial inclusion criteria for the report, 159,201 (69.4%) had continuous enrollment in the database for the nine-month period of care. Median full price of related treat all ACL patients was $13,403.38 (Tabular array 3). The median full health intendance costs for ACL surgery also increased over the study menstruation from $10,891.41 in 2005 to $14,692.65 in 2022, although the relative increment was reduced when the costs were adjusted to 2022 value (Effigy two). Patients who underwent concomitant collateral ligament (MCL, LCL) repair or reconstruction had the highest total cost as well as the greatest difference in median costs between the firsthand process and total health care utilization. Patients who underwent isolated ACL repair or reconstruction had the lowest total toll; however, patients who underwent ACL repair or reconstruction with concomitant microfracture had the smallest difference in median costs betwixt the immediate procedure and full health intendance utilization.
Table 3
Total Cost of Health Care Utilization Related to the Outpatient Arthroscopic ACL Reconstruction, Identified Using Any Articulatio genus-Related Diagnosis Lawmaking Billed for the Patient During the 9-Month Period of Care, Among Patients Included in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, 2005-2013 (N = 159,201) a
| Procedure | Northward | Hateful, $ | Median, $ | 25th Percentile, $ | 75th Percentile, $ | Median, Excluding Immediate Process Costs, $ |
|---|---|---|---|---|---|---|
| All ACL | 159,201 | 15,457.06 | 13,403.38 | 9776.07 | 18,821.63 | 4003.89 |
| ACL only | 54,965 | 14,230.05 | 12,348.86 | 8978.30 | 17,462.48 | 4071.98 |
| ACL + meniscectomy | 80,059 | 15,880.37 | 13,806.30 | 10,173.54 | nineteen,233.23 | 3861.29 |
| ACL + meniscal repair | 26,086 | 17,569.88 | xv,248.86 | 11,307.forty | 21,317.68 | 4395.31 |
| ACL + chondroplasty | 12,714 | 15,485.28 | 13,298.28 | 9667.70 | 18,764.00 | 3778.eleven |
| ACL + microfracture | 8082 | 16,642.17 | 14,091.64 | ten,059.17 | 20,050.77 | 3492.04 |
| ACL + collateral ligament | 2713 | 20,101.06 | 17,006.34 | 12,212.57 | 24,567.22 | 4533.10 |
| ACL + PCL | 1242 | 20,435.81 | sixteen,358.12 | x,460.48 | 26,590.69 | 4581.27 |
Annual trends for median total price of health care utilization related to the outpatient arthroscopic inductive cruciate ligament reconstruction, identified using any knee-related diagnosis lawmaking billed for the patient during the ix-month flow of care, among patients included in the Truven Wellness Analytics MarketScan Commercial Claims and Encounters database, 2005-2013 (N = 159,201).
An analysis of patients who underwent 1 ACL reconstruction observed in the database compared with patients who underwent 2 or more ACL reconstructions observed in the database showed that full immediate procedure cost for the subsequent reconstruction was slightly lower than the full immediate procedure toll for the index reconstruction (Table iv). Yet, the full toll for health care utilization during the ix-month menstruation of care surrounding the reconstruction was greater for the subsequent reconstruction than for the index reconstruction. On boilerplate, there were 0.77 ± 0.71 (SD) concomitant procedures performed during a subsequent reconstruction, compared with 0.83 ± 0.72 during the index reconstruction (2-sample t test, P < .0001).
Table 4
Immediate Procedure and Total Health Care Utilization Costs of Outpatient Arthroscopic ACL Reconstruction Comparing the Cost of the First ACL Reconstruction to the Price of Subsequent ACL Reconstructions Among Patients Included in the Truven Wellness Analytics MarketScan Commercial Claims and Encounters Database, 2005-2013 a
| Due north | Mean, $ | Median, $ | 25th Percentile, $ | 75th Percentile, $ | |
|---|---|---|---|---|---|
| Immediate process | |||||
| First b ACL reconstruction | 213,732 | 11,482.10 | 9445.26 | 6564.46 | 14,179.49 |
| Subsequent ACL reconstruction | 15,714 | 10,744.29 | 8685.73 | 5060.74 | 13,866.92 |
| Full health care utilization | |||||
| Outset b ACL reconstruction | 147,827 | 17,353.97 | 15,000.36 | 11,017.87 | xx,977.58 |
| Subsequent ACL reconstruction | 11,374 | 19,016.54 | sixteen,238.43 | 11,775.91 | 23,100.62 |
To determine the sensitivity of our findings for total wellness intendance costs to the selection of method used to determine claims related to the reconstruction, nosotros compared the method used to produce the results presented above ("whatsoever knee-related diagnosis in 9-month window") to ii alternate methods ("diagnosis lucifer in 9-month window" and "all claims in 9-month window") (Table 5).
Tabular array 5
Comparison of Methods for Determining Cost of Total Health Care Utilization Costs Related to the Outpatient Arthroscopic ACL Reconstruction Amongst Patients Included in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, 2005-2013 (Northward = 159,201) a
| Method | Mean, $ | Median, $ | 25th Percentile, $ | 75th Percentile, $ | |
|---|---|---|---|---|---|
| Preferred | Any articulatio genus diagnosis b | 15,457.06 | 13,403.38 | 9776.07 | eighteen,821.63 |
| Alternate 1 | Whatsoever diagnosis c | 17,472.75 | 15,083.72 | eleven,068.38 | 21,127.35 |
| Alternate 2 | Diagnosis match d | 12,144.00 | 10,319.91 | 6738.98 | xv,441.70 |
The "diagnosis match in ix-month window" method resulted in mean and median total costs that were xiii% lower than those obtained using the "any knee-related diagnosis in ix-month window" assumption, while the "all claims in nine-calendar month window" costs were 23% college.
Word
This study provides a descriptive analysis of the cost of ACL reconstruction amid commercially insured patients in the United States that can exist used to better understand the effect of these injuries on the health intendance organisation. These results provide a glimpse into the injuries that lead to the burden of musculoskeletal problems in the Usa. In 2010, musculoskeletal bug resulted in an estimated $170 billion in health care spending in the United States, ranking third backside circulatory conditions ($234 billion) and prevention, colds, and other bones intendance ($207 billion).1 The results clearly justify the need for increased population-based musculoskeletal inquiry.
The incidence of ACL injuries14,15 and the high costs identified for the wellness intendance system provide additional support for implementation of injury prevention initiatives and other cost-saving programs. The documentation of toll of surgical intervention can be used to refine price-do good analyses of injury prevention programs. Additionally, the increased cost of health care utilization associated with subsequent reconstructions, in improver to the evidence that patients who sustain 1 ACL injury are at hazard for a 2nd injury,sixteen,18,19 suggests that injury prevention programs should exist developed and validated in order to incorporate them into the rehabilitation protocol for patients recovering from ACL reconstruction. In particular, it should exist noted that 25% of the patients in this report were younger than 18 years, and this group is more likely to accept a revision or contralateral ACL reconstruction.8,xviii Future enquiry should use the information provided from this written report to perform cost-benefit and price-effectiveness analyses for ACL injury prevention and other cost-saving programs.
Concomitant Procedures and Multiple Injuries
An analysis comparing cost of an isolated ACL reconstruction to price of ACL reconstruction with various concomitant procedures suggested that both immediate procedure and total wellness care costs were greatest among patients who underwent concomitant collateral ligament (MCL, LCL) repair or reconstruction, followed by concomitant PCL reconstruction and concomitant meniscal repair. These procedures also had the highest deviation in median costs between the firsthand procedure and full health care utilization, which suggests higher health care costs during the perioperative flow. These additional procedures probable reflect more severe injuries that require boosted surgical supplies, increased surgical time, and additional physical therapy and other rehabilitation costs. It is important to note that the categories of concomitant procedures are not mutually sectional. Therefore, a patient who had multiple concomitant procedures (eg, ACL reconstruction, collateral ligament repair, and meniscal repair) would have his or her costs included in each procedure calculation (eg, collateral ligament and meniscal repair).
Our expectation was that subsequent reconstructions would be more than costly than initial reconstructions due to the potential for increased intra-articular damage at the time of the 2nd reconstruction. However, the data advise that patients who had more than ane ACL reconstruction observed in the database have a slightly lower mean immediate procedure cost for the subsequent reconstructions ($8685.73 vs $9445.26). Contrary to our expectations, patients who had a subsequent ACL reconstruction had fewer concomitant procedures performed at the subsequent procedure compared with the initial procedure (0.76 ± 0.70 vs 0.82 ± 0.71, respectively). These results may exist due to the inability to distinguish between revision and contralateral reconstructions in the second reconstruction category.
Although the firsthand procedure cost was similar between the first and subsequent reconstructions, the price of health intendance utilization was slightly greater for the 9-month menstruation of intendance around subsequent reconstruction compared with the first ($16,238.43 vs $15,000.36). This suggests that patients may require more wellness care utilization, such as physical therapy or imaging, afterwards a 2d reconstruction. Consequently, patients who undergo more than 1 ACL reconstruction should be a priority when identifying strategies to reduce the burden of health care costs in orthopaedics.
Limitations
In that location are limitations to this descriptive analysis of cost of ACL reconstruction. Showtime, this report just includes ACL reconstructions that were performed arthroscopically in the outpatient setting. While outpatient arthroscopic reconstruction currently represents the bulk of ACL reconstructions performed in the United states,2,14 the results are not generalizable to open or inpatient ACL reconstructions. Similarly, our methodology specifically utilized a database created out of records for patients who have commercial insurance, and thus, the results are only generalizable to that population. Specifically, this database merely contains individuals who are <65 years old who are commercially insured. It is expected that the incidence and presentation of ACL rupture may be very different among individuals ≥65 years old, which could influence the costs associated with ACL reconstruction. This database too does non contain individuals who are insured past Medicaid, which insures low-income patients, or uninsured patients, and costs associated with ACL reconstruction may likewise exist quite different amongst those subsets of the population. As well, the immediate procedure cost was determined by summing payments for a 3-day window surrounding the procedure. This decision was made in gild to account for aggregate costs of the procedure, including associated costs for the facility, physician, anesthesia, and other care. Although this choice may result in small-scale misclassification of other claims into the immediate procedure costs, the nature of this type of procedure, including the typical acute presentation, mean that this window is advisable for calculating the firsthand procedure costs. Unfortunately, nosotros were not able to assess procedure costs more granularly, such as specific equipment or facility expenses. Therefore, we cannot comment on whether a specific area contributed most to rise procedure costs. In the analysis of subsequent injuries, we were unable to distinguish between revision ACL reconstruction and contralateral ACL reconstruction due to lack of laterality information in this database. The power to identify truthful revision ACL reconstruction would be potentially valuable in understanding health care arrangement costs, particularly health intendance utilization surrounding the procedure. Even so, we believe the information is still valuable for understanding the health intendance costs associated with multiple reconstructions versus a single reconstruction. In add-on, it is possible that some patients had a prior ACL reconstruction that was not captured in the database or in the study. We required that patients have simply iii months of continuous enrollment in the database prior to the reconstruction. This likely results in some misclassification of prior injuries as first injuries and may have adulterate the difference in price betwixt first and subsequent injuries.
For the purposes of this study, we used a 9-calendar month period for determining health care utilization, based on previous literature virtually the typical period of care7,12; however, costs of complex injuries or those who sustain complications related to the procedure may non exist fairly represented in this assay due to the cutoff at 6 months postoperative for reporting cost. The method used (any knee-related diagnosis code) could include charges from a knee injury that were unrelated to the ACL surgery, but could also potentially miss charges that were related to the ACL surgery but were non knee related, such as postoperative infection or complications from anesthesia. This approach has to exist weighed against the limitations of the 2 other methods. Using a 9-month period of care and considering all charges to be related to the ACL surgery likely overestimates the toll of the procedure past including incurred charges that were unrelated. On the other manus, the method using a diagnosis code match of the procedure to other charges billed likely underestimates the cost of the procedure by excluding incurred charges that were related, since some episodes of intendance may not be linked past diagnosis code due to nuances of billing methods.
Finally, this report did not compare the costs of the process to other ACL treatment options, as this was a descriptive analysis using an insurance claims database. We likewise did not perform statistical analyses to assess the significance of the tendency over fourth dimension; nonetheless, the results were adapted to 2022 values to account for inflation, allowing for visual comparison over time. Finally, nosotros were not able to include other measures of economic burden, including lost wages or disability-adjusted life years (DALYs).
Conclusion
These results provide a foundation for understanding the public health burden of ACL injuries in the United states. Our findings suggest that further research on the prevention and treatment of ACL injuries is necessary to reduce this burden.
Footnotes
1 or more of the authors has alleged the following potential disharmonize of involvement or source of funding: Major funding for this research came from a grant provided by the University of Northward Carolina Inferior Development Honour. The University of North Carolina Injury Prevention Research Center is partially supported past an honor (R49CE002479) from the National Center for Injury Prevention and Command, Centers for Illness Command and Prevention. J.50.L. receives enquiry funding from the UNC K12 Oncology Clinical Translational Inquiry Training Program (5K12CA120780) and salary support from the PhRMA Foundation to the Section of Epidemiology at Academy of North Carolina at Chapel Hill (UNC).
Upstanding approval for this study was waived past the University of North Carolina at Chapel Colina Institutional Review Board.
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How Much Does Acl Repair Surgery Cost,
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