Distal biceps tendon repair: cost analysis of single- versus double-incision techniques in an ambulatory surgery center

Abstract

The purpose of this study was to compare the cost differences for single- versus double-incision distal biceps repair at an ambulatory surgery center (ASC) given that similar clinical outcomes have been reported between these methods. A retrospective review of financial and medical records was completed for patients who underwent distal biceps tendon repair over a three-year period at a single private orthopedic practice. Variables analyzed include the cost to the ASC of operative time and the cost of differential surgical supplies, specifically implants and disposable supplies. A total of 10 surgeons performed 104 repairs. Nine surgeons performed repairs through a single incision with use of cortical button or suture anchor fixation, and one surgeon performed transosseous suture fixation through a double-incision approach. The median tourniquet time and procedure length were 31 (interquartile range [IQR] 27-40) and 44 (IQR 39-54) minutes for single-incision repairs and 68 minutes (IQR 61-75) and 110 minutes (IQR 103-113) for double-incision repairs which were significantly different across groups (P < .001, P < .001). The total surgical cost (operative time, implants, and disposables) for single-incision repairs was a median of $758 (IQR 732-803) compared with $606 (IQR 567-629) for double-incision repairs (P < .001). However, the procedure cost with implants (not including disposables) was not significantly different for single- (median [Mdn]= $500 [IQR 475-552]) and double-incision repairs (Mdn $552 [IQR 514-564]) (P= .14) although the procedure cost with disposables (not including implant costs) favored single-incision repairs (Mdn= $478 [IQR 452-523]) over double-incision repairs (Mdn= $606 [IQR 567-629]) (P < .001). In a single surgery center, single-incision distal biceps repairs utilizing an implant were performed more expeditiously than double-incision repairs with a transosseous technique but incurred greater surgical costs. Differences in surgical time cost between the two approaches could be consequential for ASCs and other stakeholders.