A Comparative Analysis of Resource Utilization Between Proximal Row Carpectomy and Partial Wrist Fusion: A Population Study

Abstract

There is no financial information to disclose. We conducted a population-level analysis comparing proximal row carpectomy (PRC) and partial wrist arthrodesis (PWA) for treatment of chronic wrist arthritis to (1) characterize national practice patterns, (2) determine the rate of conversion to total wrist arthrodesis (TWA), and (3) calculate the associated cost of care. Our null hypothesis is that there are no significant differences in rates of total wrist fusion between PRC and PWA, but that the total number of procedures and the cost is greater with PWA. Using the Truven MarketScan databases from 2009 to 2014, we identified patients 18 years or older with a diagnosis of wrist osteoarthritis who had a PRC or PWA and were followed for 18 months, controlling for sex, income, insurance type, and comorbidity score. We used Chi-squared analysis and multivariate logistic analysis to evaluate the conversion to TWA with each procedure. Rates of repeat PWA were also obtained, including the total number of procedures until completion, and treatment cost. Of a total of 3,388 eligible patients, 1,305 had a PRC (39%), and 2,083 had a PWA (61%). In patients 54 years of age or younger PWA was more commonly performed compared to PRC (49% vs. 38%). TWA rates were significantly higher for patients of all ages who underwent PWA (19.2%) versus PRC (5.9%; P < 0.001), with PWA patients having four times greater odds of subsequent TWA compared to PRC (OR: 4.0, 95% CI: 2.9-5.5). Patients undergoing PWA required more total procedures compared to those who received a PRC (average 1.7 vs 1.1) resulting in a greater average cost per patient ($11,525 vs. $7,171). (Tables 4-1 and 4-2) •Conversion rates to a TWA are significantly higher with a PWA (19.2%) than PRC (5.9%) for all age groups.•Although younger patients are more often treated with PWA, high conversion rates to a TWA suggest that there may need to be a paradigm shift in this practice pattern.•Given the significantly lower cost and fewer required procedures, PRC places less of a burden on the patient and the healthcare system.Table 4-1Practice Patterns Demonstrating Number of Patients Who Had a Proximal Row Carpectomy (PRC) or Partial Wrist Arthrodesis (PWA) for Each Age GroupAgePRCPWA18-3459 (5%)135 (6%)35-4481 (6%)236 (11%)45-54358 (27%)647 (31%)55-64516 (40%)737 (35%)65 and up291 (22%)328 (16%)Total13052083 Open table in a new tab Table 4-2Eighteen Month Follow-up Comparing Those Who Had Proximal Row Carpectomy (PRC) and Partial Wrist Arthrodesis (PWA) Evaluating Final Outcome, Average Number of Procedures to Reach Final Outcome, and Average CostOutcomeAverage Number of ProceduresAverage Cost (Per Patient)SuccessfulTotal Wrist ArthrodesisRepeat PWAPRC1226 (94.1%)77 (5.9%)N/A1.1$7,171PWA1581 (75.9%)400 (19.2%)102 (4.9%)1.7$11,525 Open table in a new tab