Surgeon Preferences, Surgical Location, and Timing of Repair Drive Achilles Tendon Rupture Repair Cost

Midsubstance Achilles tendon repair is a common procedure, yet the factors influencing its cost have been underexamined and often imprecisely understood. Using time-driven activity-based costing (TDABC), we examined variation in total cost, compared patient-, surgeon-, and surgery-specific characteristics between high- and non-high-cost repairs, and assessed factors associated with total cost to identify specific cost drivers that might reduce expenses without compromising clinical outcomes.

Patients undergoing midsubstance Achilles tendon rupture repair between January 3, 2022 and December 28, 2023 at 2 academic medical centers and their affiliated community hospitals and ambulatory surgical centers were identified. Exclusion criteria included revision procedures and those with concurrent procedures besides fasciotomy. TDABC methodology was used to determine total cost across 3 clinical phases: preoperative, intraoperative, and postoperative. Cost was normalized per institution requirements. Bivariate analysis was performed across all characteristics between high-cost (top decile) procedures and all others. Spearman correlation between operative time and total cost was assessed. Multivariable linear regression was used to identify key cost drivers.

Among 341 primary midsubstance Achilles rupture repairs performed by 8 surgeons, the most expensive procedure was 6 times costlier than the least expensive one. Eighty-five percent of the cost, on average, was incurred intraoperatively. A "good" correlation was found between operative time and total cost (P < .05). When accounting for covariates, increasing time between rupture and repair was associated with higher cost (P < .05). Surgical location, surgical approach, and repair suture were also associated with total cost (P < .05).

Substantial variability in the cost of primary midsubstance Achilles rupture repair is driven by factors including timing of surgical repair, intraoperative surgeon-specific characteristics (ie, surgical approach and suture choice), and surgical location. Further standardization of treatment approach and decreasing time to the operating room could lower cost variability and improve the value of care for patients with midsubstance Achilles tendon rupture undergoing surgery.