Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?

Riley Swenson; Thomas Paull; Gaonhia Moua; David Weatherby; Khalid Azzam; Robert Wojahn; Sarah Anderson; Peter A Cole; Mai Nguyen

doi:10.1177/24730114241247826

Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?

Foot Ankle Orthop. 2024 Apr 23;9(2):24730114241247826. doi: 10.1177/24730114241247826. eCollection 2024 Apr.

Authors

Riley Swenson¹, Thomas Paull^{1

2}, Gaonhia Moua^{1

2}, David Weatherby^{1

2}, Khalid Azzam^{1

2}, Robert Wojahn^{1

2}, Sarah Anderson^{1

2}, Peter A Cole^{1

2}, Mai Nguyen^{1

2}

Affiliations

¹ University of Minnesota, Minneapolis, MN, USA.
² Regions Hospital, Saint Paul, MN, USA.

Abstract

Background: Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior.

Methods: Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey.

Results: The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was -$204.80 (P = .68), whereas the mean cost difference for bimalleolar fractures was -$9.82 (P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 (P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs (P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study.

Conclusion: The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone.

Level of evidence: Level III, case control study.

Keywords: ORIF; ankle fracture; cost; fracture; surgeon preference.