Purpose
To evaluate how both annual surgeon and facility volume affect the cost and outcomes
of anterior cruciate ligament reconstruction surgery. We also aimed to identify trends
in how surgeon caseload predicts graft selection.
Methods
The 2014 State Ambulatory and Surgical Database from Florida was used. Every case
with Current Procedural Terminology code 29888 (“Arthroscopic anterior cruciate ligament
reconstruction”) was selected. Surgeon and facility identifiers were used to separate
high- and low-volume groups, defined as >25 cases for surgeons and >125 cases for
facilities. Univariate analysis was performed for patient demographics and surgical
characteristics. Multivariate analysis was performed on significant factors to determine
how these variables impact cost and odds of allograft usage, postoperative admission,
and meniscal repair.
Results
There were 7905 cases performed between January 1, 2014, and December 31, 2014 after
excluding same-year revisions. High-volume surgeons had $6155 lower total charges,
were 1.949 times more likely to use an autograft, and had 54.5% lower odds of postoperative
admission (all P < .001). They were also 1.196 times more likely to perform a meniscal repair (P = .017). In patients younger than 18, low-volume surgeons were 3.7 times more likely
to use an allograft (P < .001). Concomitant multiligamentous procedures were also performed at greater rates
in the high-volume group. Postoperative admission added $18,698, and allografts added
$9174 (both P < .001).
Conclusions
We found that high-volume surgeons were more likely to perform a meniscal repair and
less likely to have their patients admitted postoperatively, which was the second
largest cost driver of anterior cruciate ligament reconstruction. They were also significantly
less likely to use an allograft, especially in patients younger than the age of 18
years. High-volume surgeons had lower costs despite greater rates of concomitant procedures.
Level of Evidence
III, retrospective cohort study.
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Article info
Publication history
Published online: August 20, 2020
Accepted:
August 15,
2020
Received:
February 15,
2020
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: S.L.B. reports personal fees from Zimmer Biomet and Stryker, outside the submitted work. S.F.D. reports personal fees from Zimmer Biomet, outside the submitted work. B.D.O. reports personal fees from DePuy Synthes, Musculoskeletal Transplant Foundation, Vericel, and Linvatec, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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