Effect of Facility on Operative Costs of Total Ankle Arthroplasties

Cost containment and bundled payments are becoming increasingly important in health care. The purpose of this study was to investigate if ambulatory surgery centers (ASCs) can deliver lower cost care and to identify sources of those cost savings in total ankle replacement (TAR). A cost identification analysis of primary TAR was performed at a single academic medical center. Multiple costs and time measures were taken from 730 consecutive patients over 5 years at either an inpatient facility or ASC. The relationships between total cost and operative time and multiple variables were examined, using multivariate analysis and regression modeling. The mean operative cost over 4 years was significantly greater at the inpatient facility than at the outpatient facility. Significant cost drivers of this difference were inpatient, physical and occupational therapy, pharmacy, and operating room costs. The most significant predictor of cost was facility type. This study supports the use of ASC facilities to achieve efficient resource use in the operative treatment of~total ankle arthroplasties (Journal of Surgical Orthopaedic Advances 27(4):321-324, 2018).