Relationship between implant use, operative time, and costs associated with distal biceps tendon reattachment

The suture anchor and transosseous drill hole techniques for reattachment of the distal biceps tendon to the radius have been found to have similar clinical and biomechanical outcomes. However, a comparison of the cost effectiveness of these techniques is lacking. The purpose of this study was to determine whether the use of suture anchors decreases operative time enough to offset the additional cost of the implants. The records of all patients undergoing a distal biceps tendon reattachment were reviewed to determine the method of fixation, operative time, and associated surgical costs. Two surgeons used a technique of fixing the tendon directly to the bone (transosseous group), whereas 3 surgeons used suture anchors. Given the standard nature of the surgical procedure (other than the fixation technique), only the costs that differed between the 2 groups were included. Surgical center costs were obtained from the local outpatient surgical center in 2011 US dollars. Five surgeons treated 70 men (mean age, 45.9±9.2 years). Mean time from injury to surgery was 14 days. Mean operative times for the transosseous and suture anchor groups were 97.6±14.9 and 95.8±25.8 minutes, respectively (P=.74). Two anchors were used in 79% of the anchor cases. The use of anchors cost $474.33 more per patient. However, this value is sensitive to the cost of the individual anchors, intersurgeon variation in operative time, and per-minute value of saved operative time. No operative time was saved with the use of suture anchors. This cost comparison framework can be used to evaluate the balance in surgical resource use due to implant cost vs savings in operative time.