Cost analysis of different fixation techniques for distal biceps ruptures using time-driven activity-based costing

Various fixation methods of distal biceps brachii tendon rupture (buttons, screws, and anchors) have been shown to have similar outcomes. However, the impact of these different implants on total day of surgery (DOS) costing has yet to be examined. The purpose of this study was to explore the DOS costs between different types of implants used for distal biceps repairs using time-driven activity-based costing.

A retrospective review of all patients who underwent primary operative treatment for distal biceps rupture from January 2018 through May 2025 within a single medical system was conducted. Inclusion criteria consisted of patients who had surgical repair of a torn distal biceps brachii tendon. Exclusion criteria included having had a surgery other than a distal biceps repair, history of prior surgery on the affected biceps brachii tendon, incomplete costing or implant data, and revision distal biceps repairs. Patient demographics, implant types, operative characteristics, anesthesia data, retear and revision rates, and DOS costing were evaluated. Statistical analyses conducted included descriptive statistics, t-tests, Mann-Whitney U tests, and linear regressions to identify cost drivers.

Of the 433 patients who met the inclusion criteria, 96.8% (n = 419) were male with a mean age of 50.2 ± 10.1 years and a mean body mass index of 31.2 ± 5.8 kg/m². The average operative time was 59.8 ± 20.1 minutes. Fixation techniques included buttons (42.7%), suture anchors (20.3%), and a combination of buttons and screws (37.0%). The average total DOS cost was $2,146.70±$539.29. Operative times were significantly different between fixation techniques (P = .002). Retears occurred in only 2 (0.5%) patients, both of whom received only suture anchors for fixation.

The total DOS costs for distal biceps repairs were lowest when suture anchors were used and highest when buttons and screws were used. Significant predictors of cost included the type of fixation, operative time, implant manufacture, anesthesia type, and age (all P < .05). Operative time and total implant cost together accounted for 80.8% of total DOS cost variance. These findings suggest that suture anchors may offer a cost-effective option without compromising clinical outcomes. Within the current atmosphere of value-based care in orthopedics, these findings can help equip surgeons in efforts to be more cost-aware in decision-making.