Total Payments and Out-of-Pocket Expenses for Surgical Hand Trauma Episodes

Insight about episode spending after elective procedures has driven interest in bundling reimbursement for surgical procedures. However, little is known about episode spending for health systems (payments) and patients (out-of-pocket [OOP] expenses) after unplanned, nonelective procedures such as hand trauma.

The authors used 2019-2022 national claims to conduct a cohort study of patients undergoing flexor tendon repair, open reduction internal fixation (ORIF) of a distal radius fracture, and replantation/revascularization. The authors constructed 90-day episodes spanning surgical procedures and postoperative care. The authors calculated episode spending from the perspectives of the health system (payments) and patients (OOP expenses). Multivariable regression models were used to examine the association between patient characteristics and spending.

Among 21,753 patients, 90-day postoperative spending varied by procedure type. Median payment was $14,263 for ORIF of distal radius fractures, $11,541 for flexor tendon repairs, and $25,700 for revascularization/replantation. Compared to ORIF of distal radius fractures, flexor tendon repairs were associated with 18% lower payments (cost ratio, 0.82; 95% confidence interval [CI], 0.80-0.83), while revascularization/replantation was associated with 7% lower payments (cost ratio, 0.93; 95% CI, 0.90-0.97). Patients with at least one comorbidity had 4% greater payments compared to patients with no comorbidities (cost ratio, 1.04; 95% CI, 1.03-1.06). However, inpatient procedures were 388% more expensive than outpatient procedures (cost ratio, 3.77; 95% CI, 3.77-3.99). The authors also found variation in patient OOP expenses based on procedure type.

There was heterogeneity in health system and patient spending after hand trauma due to procedure type. This highlighted that any future payment or practice redesign for hand trauma episodes should be stratified by procedure type.