Session VIII - General Interest

Sat., 10/12/13 Topics of General Interest, PAPER #87, 12:36 pm OTA 2013

Do Surgeons Know the Cost of Orthopaedic Trauma Implants? A Multicenter Study of 503 Surgeons

Kanu Okike, MD, MPH1; Robert V. O’Toole, MD1; Andrew N. Pollak, MD1;
Julius A. Bishop, MD2; Christopher M. McAndrew, MD3; Samir Mehta, MD4;
William Cross, MD5, Grant Garrigues, MD6; Mitchel B. Harris, MD7;
Christopher T. Lebrun, MD1;
1University of Maryland, Baltimore, Maryland, USA;
2Stanford University, Palo Alto, California, USA;
3Washington University, St Louis, Missouri, USA;
4University of Pennsylvania, Philadelphia, Pennsylvania, USA;
5Mayo Clinic, Rochester, Minnesota, USA;
6Duke University, Durham, North Carolina, USA;
7Brigham and Women’s Hospital, Boston, Massachusetts, USA

Background/Purpose: Implant costs represent a substantial portion of health-care expenditures, and orthopaedic surgeons are positioned to play a key role in controlling these costs. A knowledge of implant costs is essential in this process; however, it is unknown if orthopaedic surgeons are knowledgeable in this domain. The purpose of this study was to assess orthopaedic surgeons’ knowledge of common orthopaedic trauma implant costs. Our hypothesis was that orthopaedic surgeons would demonstrate a low level of implant cost knowledge.

Methods: This IRB-approved study was designed as an online survey administered to attending orthopaedic surgeons and residents at 7 academic medical centers associated with trauma centers. The survey consisted of 10 common orthopaedic trauma implant constructs that were each identified with a radiograph as well as an itemized component list. At each institution, the most commonly used vendors were chosen to maximize surgeon familiarity with the implant constructs. The actual cost of each construct (defined as the contracted amount paid to the vendor by the institution) was determined at each institution and then compared with the respondents’ estimates. Estimates that were as discrepant as ±20% of the actual cost were considered correct.

Results: The response rate for the survey was 96% (503 of 522). Overall knowledge of implant costs among attending orthopaedic surgeons was low (mean 20% correct, 95% confidence interval [CI] 18%-22%). Attending orthopaedic trauma surgeons demonstrated greater implant cost knowledge than nontrauma surgeons in the univariate analysis (P = 0.007), but this relationship was no longer significant after controlling for frequency of implant usage and other factors (P = 0.23). In the multivariate analysis, the factors significantly associated with attending cost knowledge were number of years in practice (P = 0.03), frequency of implant usage (P = 0.009), and the price of the implant construct itself (P <0.001). Knowledge of implant costs was also low among residents (mean 16% correct, 95% CI 15%-18%, P = 0.004 compared to the attending surgeons). In the multivariate analysis, factors significantly associated with resident cost knowledge were frequency of implant usage (P = 0.01) and the cost of the implant construct itself (P <0.001). Self-assessment of implant cost knowledge was low among attending surgeons as well as residents, with 27% rating it as poor, 31% as below average, 35% as average, 6% as above average and 0.4% as excellent. However, over 80% of respondents indicated that cost should be “moderately,” “very,” or “extremely” important in the selection of orthopaedic trauma implants.

Conclusion: In this multicenter survey of 503 orthopaedic surgeons that captured 96% of potential respondents, most believed that cost should play an important role in the selection of orthopaedic implants. However, actual knowledge of implant costs was found to be low among attending surgeons as well as residents. If surgeons are expected to select lower cost implants when medically appropriate, additional education may be required to allow for this possibility.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.