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Abstract：
BACKGROUND: While Achilles tendon repairs are common, little data exist characterizing the cost drivers of this surgery.
OBJECTIVE: To examine cases of primary Achilles tendon repair, primary repair with graft, and secondary repair to find patient characteristics and surgical variables that significantly drive costs.
METHODS: Economic and decision analysis; Level of evidence, 3.
METHODS: A total of 5955 repairs from 6 states were pulled from the 2014 State Ambulatory Surgery and Services Database under the Current Procedural Terminology codes 27650, 27652, and 27654. Cases were analyzed under univariate analysis to select the key variables driving cost. Variables deemed close to significance (P < .10) were then examined under generalized linear models (GLMs) and evaluated for statistical significance (P < .05).
RESULTS: The average cost was $14,951 for primary repair, $23,861 for primary repair with graft, and $20,115 for secondary repair (P < .001). In the GLMs, high-volume ambulatory surgical centers (ASCs) showed a cost savings of $16,987 and $2854 in both the primary with graft and secondary repair groups, respectively (both P < .001). However, for primary repairs, high-volume ASCs had $2264 more in costs than low-volume ASCs (P < .001). In addition, privately owned ASCs showed cost savings compared with hospital-owned ASCs for both primary Achilles repair ($2450; P < .001) and primary repair with graft ($11,072; P = .019). Time in the operating room was also a significant cost, with each minute adding $36 of cost in primary repair and $31 in secondary repair (both P < .001).
CONCLUSIONS: Private ASCs are associated with lower costs for patients undergoing primary Achilles repair, both with and without a graft. Patients undergoing the more complex secondary and primary with graft Achilles repairs had lower costs in facilities with greater caseload.
OBJECTIVE: To examine cases of primary Achilles tendon repair, primary repair with graft, and secondary repair to find patient characteristics and surgical variables that significantly drive costs.
METHODS: Economic and decision analysis; Level of evidence, 3.
METHODS: A total of 5955 repairs from 6 states were pulled from the 2014 State Ambulatory Surgery and Services Database under the Current Procedural Terminology codes 27650, 27652, and 27654. Cases were analyzed under univariate analysis to select the key variables driving cost. Variables deemed close to significance (P < .10) were then examined under generalized linear models (GLMs) and evaluated for statistical significance (P < .05).
RESULTS: The average cost was $14,951 for primary repair, $23,861 for primary repair with graft, and $20,115 for secondary repair (P < .001). In the GLMs, high-volume ambulatory surgical centers (ASCs) showed a cost savings of $16,987 and $2854 in both the primary with graft and secondary repair groups, respectively (both P < .001). However, for primary repairs, high-volume ASCs had $2264 more in costs than low-volume ASCs (P < .001). In addition, privately owned ASCs showed cost savings compared with hospital-owned ASCs for both primary Achilles repair ($2450; P < .001) and primary repair with graft ($11,072; P = .019). Time in the operating room was also a significant cost, with each minute adding $36 of cost in primary repair and $31 in secondary repair (both P < .001).
CONCLUSIONS: Private ASCs are associated with lower costs for patients undergoing primary Achilles repair, both with and without a graft. Patients undergoing the more complex secondary and primary with graft Achilles repairs had lower costs in facilities with greater caseload.
摘要：
背景：虽然跟腱修复很常见，很少有数据描述这种手术的成本驱动因素。
目的：检查原发性跟腱修复的病例，用移植物进行初次修复，和二次修复，以发现显著驱动成本的患者特征和手术变量。
方法：经济和决策分析；证据水平，3.
方法：根据当前程序术语代码27650、27652和27654，从2014年州门诊手术和服务数据库中提取了来自6个州的总共5955件维修。在单因素分析下对案例进行分析，以选择关键变量驱动成本。然后在广义线性模型(GLM)下检查被认为接近显著性(P<.10)的变量,并评估统计学显著性(P<.05)。
结果：初级维修的平均费用为14,951美元，23,861美元，用于移植修复，二次维修费用为20,115美元（P<.001）。在GLM中，高容量门诊手术中心（ASC）显示，在主要移植和次要修复组中，成本节省了$16,987和$2854，分别(两者P<.001)。然而,对于初级维修，高容量ASCs的成本比低量ASCs高2264美元(P<.001)。此外,在跟腱修复($2450;P<.001)和移植修复($11,072;P=.019)方面,私人拥有的ASC与医院拥有的ASC相比均显示出成本节约。在手术室的时间也是一个巨大的成本，每分钟增加$36的成本在初级维修和$31的二次维修（P<.001）。
结论：PrivateASCs与接受原发性跟腱修复的患者的低成本相关，有和没有移植。接受较复杂的继发性和原发性移植物跟腱修复的患者在病例量较大的设施中成本较低。
目的：检查原发性跟腱修复的病例，用移植物进行初次修复，和二次修复，以发现显著驱动成本的患者特征和手术变量。
方法：经济和决策分析；证据水平，3.
方法：根据当前程序术语代码27650、27652和27654，从2014年州门诊手术和服务数据库中提取了来自6个州的总共5955件维修。在单因素分析下对案例进行分析，以选择关键变量驱动成本。然后在广义线性模型(GLM)下检查被认为接近显著性(P<.10)的变量,并评估统计学显著性(P<.05)。
结果：初级维修的平均费用为14,951美元，23,861美元，用于移植修复，二次维修费用为20,115美元（P<.001）。在GLM中，高容量门诊手术中心（ASC）显示，在主要移植和次要修复组中，成本节省了$16,987和$2854，分别(两者P<.001)。然而,对于初级维修，高容量ASCs的成本比低量ASCs高2264美元(P<.001)。此外,在跟腱修复($2450;P<.001)和移植修复($11,072;P=.019)方面,私人拥有的ASC与医院拥有的ASC相比均显示出成本节约。在手术室的时间也是一个巨大的成本，每分钟增加$36的成本在初级维修和$31的二次维修（P<.001）。
结论：PrivateASCs与接受原发性跟腱修复的患者的低成本相关，有和没有移植。接受较复杂的继发性和原发性移植物跟腱修复的患者在病例量较大的设施中成本较低。
