Socioeconomic Disparities and Procedural Complexity Influence Charges in Primary Patellar Instability Treatment: A...

To investigate the factors associated with charges of primary treatment options for patellar instability, analyze the financial impact of performing specific concomitant procedures, and identify critical social determinants of health care charges associated with patellar instability treatment.

This retrospective study used the 2019 Nationwide Ambulatory Surgery Sample to analyze patients with primary patellar instability undergoing a single stabilization procedure, including relevant concomitant procedures. Cases with multiple primary stabilization procedures or cases with unrelated concomitant Current Procedural Terminology codes were excluded. Bivariate analyses identified significant covariates, which were included in a generalized linear model to compare charges across Current Procedural Terminology codes, adjusting for patient and hospital factors.

In total, 3,035 procedures were analyzed, including 54.79% arthroscopic lateral retinacular releases, 7.45% open lateral releases, 31.73% medial patellofemoral ligament (MPFL) reconstructions, and 6.03% tibial tubercle osteotomies. On average, tibial tubercle osteotomy ($47,401) had greater charges than MPFL reconstruction ($41,333), arthroscopic lateral release ($23,930), and open lateral release ($34,520). Charges varied by patient demographics and hospital characteristics. Non-White patients faced greater charges compared with White patients ($36,051 vs $29,924, P < .001). Similarly, Hispanic patients faced greater charges than non-Hispanic patients ($38,256 vs $30,861, P < .001). Male patients were charged more than female patients (P < .001). Private hospitals charged $10,422 more than public hospitals (P < .001). Urban hospitals charged $3,929 more than hospitals in rural locations. Osteochondral grafting increased charges by $35,816 (P < .001).

This study highlights significant variability in charges for patellar instability treatments, influenced by procedural complexity, concomitant interventions, and demographic factors. Tibial tubercle osteotomy was the most expensive treatment option, followed by MPFL reconstruction. Concomitant osteochondral grafting significantly increased charges. Disparities in charges were evident on the basis of patient demographics and hospital characteristics, with greater charges associated with non-White race, Hispanic ethnicity, and procedures performed in private hospitals or urban hospitals.

Understanding cost drivers in patellar instability treatment can inform clinical decision-making, resource allocation, and efforts to address health care disparities in orthopedic and sports medicine care.