This level II evidence study was approved by the College of Medicine Institutional Review Board. Retrospective chart and financial billing reviews were performed on 28 consecutive patients who underwent primary ACLR from January 2019 to December 2019 at a single academic institution. Exclusion criteria were: multiligamentous knee injury and age < 18. Three fellowship-trained sports medicine surgeons operated on the patients.
Data extracted included: age, gender, ethnicity, body mass index (BMI), surgeon, length of operation (LOO), regional block used, implants used, associated meniscus surgery in addition to ACLR (yes or no) and if so, what type of meniscus surgery (partial meniscectomy or repair), graft type [allograft (ALLO) versus autograft (AUTO)], and autograft choice, including bone-patellar tendon-bone (BPTB), quadrupled hamstring (HAM) or quadriceps tendon (QUAD).
Financial information extracted included charges associated with grafts, anesthesia, radiology, pharmacy, implants, supplies, operating room (OR), anesthesiologist, and surgeon. The total charges and final amount that insurance and patient paid were also obtained. LOO was defined as incision start time to surgery end time. Surgical stage reflected the OR charge. Shared charges reflected the surgical fee from the hospital based on OR charge. Individual surgeons’ and anesthesiologists’ professional fees were billed separately. We define “cost” as the exact dollar amount the hospital was compensated to cover the ancillary and direct operating room charges of ACLR within the 90-day care window. Charges for intraoperative imaging were included under radiology and charges for durable medical equipment were included under supplies. Primary insurance type was also extracted and subcategorized as government or private. The charges that the insurance pays depend on the type of insurance taken by the patient as patients can take a better insurance for a higher cost cover.
Descriptive statistics were used, including frequencies and percentages for categorical measures, and means and ranges for continuous measures. The distribution of each surgical outcome was evaluated for approximate normality and transformed using the natural log transformation, if necessary. Potential predictors were evaluated separately for each of the surgery outcomes using analysis of variance (ANOVA) and with simultaneous adjustment for other significant predictors using analysis of covariance (ANCOVA). Potential predictors that were compared included surgeon, LOO, graft choice, concomitant meniscus surgery, use of regional block, radiology, and insurance type. Results were reported in terms of model-adjusted means and 95% confidence intervals. Significance was defined as p<0.05, and statistical tests were performed using SAS statistical software version 9.4 (SAS Institute, Inc., Cary, NC).
Data extracted included: age, gender, ethnicity, body mass index (BMI), surgeon, length of operation (LOO), regional block used, implants used, associated meniscus surgery in addition to ACLR (yes or no) and if so, what type of meniscus surgery (partial meniscectomy or repair), graft type [allograft (ALLO) versus autograft (AUTO)], and autograft choice, including bone-patellar tendon-bone (BPTB), quadrupled hamstring (HAM) or quadriceps tendon (QUAD).
Financial information extracted included charges associated with grafts, anesthesia, radiology, pharmacy, implants, supplies, operating room (OR), anesthesiologist, and surgeon. The total charges and final amount that insurance and patient paid were also obtained. LOO was defined as incision start time to surgery end time. Surgical stage reflected the OR charge. Shared charges reflected the surgical fee from the hospital based on OR charge. Individual surgeons’ and anesthesiologists’ professional fees were billed separately. We define “cost” as the exact dollar amount the hospital was compensated to cover the ancillary and direct operating room charges of ACLR within the 90-day care window. Charges for intraoperative imaging were included under radiology and charges for durable medical equipment were included under supplies. Primary insurance type was also extracted and subcategorized as government or private. The charges that the insurance pays depend on the type of insurance taken by the patient as patients can take a better insurance for a higher cost cover.
Descriptive statistics were used, including frequencies and percentages for categorical measures, and means and ranges for continuous measures. The distribution of each surgical outcome was evaluated for approximate normality and transformed using the natural log transformation, if necessary. Potential predictors were evaluated separately for each of the surgery outcomes using analysis of variance (ANOVA) and with simultaneous adjustment for other significant predictors using analysis of covariance (ANCOVA). Potential predictors that were compared included surgeon, LOO, graft choice, concomitant meniscus surgery, use of regional block, radiology, and insurance type. Results were reported in terms of model-adjusted means and 95% confidence intervals. Significance was defined as p<0.05, and statistical tests were performed using SAS statistical software version 9.4 (SAS Institute, Inc., Cary, NC).
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