Assessing the costs of midfoot arthrodesis: A retrospective cohort study

This retrospective cohort study aims to determine the economic cost of midfoot arthrodesis when treating midfoot arthritis, identifying the major driving forces of cost. A retrospective analysis was conducted on midfoot arthrodesis cases in South Carolina from 2012 to 2020 using the South Carolina Revenue and Fiscal Affairs (SCRFA) database. Patient cases were identified by ICD-9, ICD-10, or CPT code, yielding a total of 1,313 cases included in our analysis. Patients undergoing midfoot arthrodesis were primarily female (71.1 %), Caucasian (74.6 %), insured through commercial insurance (40.2 %) or Medicare (37.3 %), and had a mean age of 54.27 years (range 4-86). The mean total cost per midfoot arthrodesis was $54,307.08 (range $9,433.05-$120,664.29) and the mean length of stay was 1.26 (range 1-6) days. Total charges trended upward from $42,857 in 2012 to $58,643.43 in 2020. Upon analysis, the largest contributors to this cost were supplies ($27,888.28), operating room costs ($15,876.80), and anesthesia costs ($3,866.70). Notably, surgeon fees were a comparatively minor contributor ($670.49). The mean total cost per midfoot arthrodesis was $54,307.08, with supplies and operating room costs exceeded 80 % of the mean total costs. With professional service (physician) fees accounting for only 1.2 % of costs, hospital systems, hospital administrators, and surgeons should consider improving their understanding of ways to reduce surgical costs, supply negotiation, and transitioning to more outpatient surgery as means to improve the value of midfoot arthrodesis care.