scholarly journals High-Volume and Privately Owned Ambulatory Surgical Centers Reduce Costs in Achilles Tendon Repair

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091239
Author(s):  
Lambert T. Li ◽  
Carlin Chuck ◽  
Steven L. Bokshan ◽  
Ryan O’Donnell ◽  
Raymond Y. Hsu ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Primary Repair ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Tendon Repair ◽  
Cost Savings ◽  
High Volume ◽  
Achilles Tendon Repair ◽  
Ambulatory Surgical Centers ◽  
Privately Owned

Background: While Achilles tendon repairs are common, little data exist characterizing the cost drivers of this surgery. Purpose: To examine cases of primary Achilles tendon repair, primary repair with graft, and secondary repair to find patient characteristics and surgical variables that significantly drive costs. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: A total of 5955 repairs from 6 states were pulled from the 2014 State Ambulatory Surgery and Services Database under the Current Procedural Terminology codes 27650, 27652, and 27654. Cases were analyzed under univariate analysis to select the key variables driving cost. Variables deemed close to significance ( P < .10) were then examined under generalized linear models (GLMs) and evaluated for statistical significance ( P < .05). Results: The average cost was $14,951 for primary repair, $23,861 for primary repair with graft, and $20,115 for secondary repair ( P < .001). In the GLMs, high-volume ambulatory surgical centers (ASCs) showed a cost savings of $16,987 and $2854 in both the primary with graft and secondary repair groups, respectively (both P < .001). However, for primary repairs, high-volume ASCs had $2264 more in costs than low-volume ASCs ( P < .001). In addition, privately owned ASCs showed cost savings compared with hospital-owned ASCs for both primary Achilles repair ($2450; P < .001) and primary repair with graft ($11,072; P = .019). Time in the operating room was also a significant cost, with each minute adding $36 of cost in primary repair and $31 in secondary repair (both P < .001). Conclusion: Private ASCs are associated with lower costs for patients undergoing primary Achilles repair, both with and without a graft. Patients undergoing the more complex secondary and primary with graft Achilles repairs had lower costs in facilities with greater caseload.

Complications of Supine Surgical Achilles Tendon Repair

2018 ◽  
Vol 39 (6) ◽  
pp. 720-724 ◽  
Author(s):  
John J. Marcel ◽  
Katherine Sage ◽  
Gregory P. Guyton
Keyword(s):  
Achilles Tendon ◽  
Supine Position ◽  
Primary Repair ◽  
Tendon Repair ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Achilles Tendon Repair ◽  
Concomitant Surgery ◽  
Tendon Surgery

Background: Open Achilles tendon surgery with the patient in the supine position potentially avoids the complications of the prone position, but the safety and viability of the supine position for this procedure are not known. The aim of this study was to test the hypothesis that supine positioning for open repair of acute Achilles tendon ruptures would be safe, with low wound and neurologic complication rates. Methods: Supine position safety in acute Achilles tendon repair was investigated. Consecutive cases of supine Achilles tendon surgical repair performed by one surgeon from 2010 to 2015 were retrospectively reviewed. Patients were included if they were surgically treated with primary repair in the supine position within 15 days of injury and did not undergo concomitant surgery. A paramedian incision 1 cm medial to the Achilles sheath was used. Initial chart review identified 161 patients who underwent any type of Achilles tendon surgery in the supine position, of whom 45 patients met the inclusion criteria. This group included 39 men and 6 women with an average age of 41 years (range, 20–66 years). Median length of follow-up was 116 days (range, 25–1,589 days). Average body mass index was 29 kg/m2 (range, 23–36 kg/m2). Results: There were no infections, sural nerve injuries, or reruptures. Conclusions: The supine position was safe for primary open Achilles tendon repair, with no wound or neurologic complications. Level of Evidence: Level IV, case series.

scholarly journals The Effect of Obesity on Achilles Tendon Repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0045
Author(s):  
Niall Smyth ◽  
Jeffery Hillam ◽  
Jonathan Kaplan ◽  
Amiethab Aiyer
Keyword(s):  
Wound Healing ◽  
Achilles Tendon ◽  
Univariate Analysis ◽  
Tendon Repair ◽  
Wound Complication ◽  
Improvement Program ◽  
Wound Healing Complication ◽  
Achilles Tendon Repair ◽  
Increased Risk ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Obesity is increasingly common and has been highlighted as a comorbidity that may negatively impact outcomes following orthopaedic surgery. Operative versus nonoperative treatment of Achilles tendon ruptures continues to be controversial, as operative treatment may slightly reduce the likelihood of rerupture but carries the inherent surgical risks. To further delineate the patients who are at risk of postoperative complications it is of value to determine whether obese patients are particularly vulnerable. The purpose of this study was to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods: Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The patients were divided into two cohorts (obese and nonobese), and peri and postoperative factors were evaluated for association with obesity. Results: A total of 2128 patients were identified, of which 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 minutes versus 56.1 minutes. The only postoperative complication that was associated with obesity was wound healing complication, based on univariate analysis. Multivariate analysis demonstrated obesity was not associated with an increased risk of wound healing complication, infection, deep venous thrombosis, or other systemic complication. Conclusion: A large segment of the patient population undergoing Achilles tendon repair is obese. In the current study, although obesity increased the likelihood of developing a wound complication following Achilles tendon repair based on univariate analysis, it was not significantly associated with any other complication.

A Biomechanical Study of Achilles Tendon Repair Augmentation Using GraftJacket Matrix

2008 ◽  
Vol 29 (3) ◽  
pp. 329-333 ◽  
Author(s):  
F. Alan Barber ◽  
John E. McGarry ◽  
Morley A. Herbert ◽  
Robert Bentley Anderson
Keyword(s):  
Achilles Tendon ◽  
Primary Repair ◽  
Tendon Repair ◽  
Rehabilitation Program ◽  
Biomechanical Study ◽  
Matched Pair ◽  
Control Group ◽  
Achilles Tendon Repair ◽  
Ultimate Failure ◽  
Strength And Stiffness

Background: Ruptured Achilles tendons benefit from primary repair by decreasing re-rupture rates and allowing earlier range of motion. A stronger repair might allow for more aggressive rehabilitation decreasing postoperative stiffness, calf atrophy, and repair site gapping. The hypothesis of this study was that human dermal allograft augmentation of an Achilles repair would significantly increase repair strength and stiffness. This study evaluated strength and stiffness of an Achilles tendon repair augmented with a human dermal allograft (GraftJacket). Materials and Methods: Eight matched pairs of human cadaver legs were used. Simulated Achilles tendon ruptures were created 4 cm proximal to the calcaneal insertion. All tendons were repaired with a Krackow locking loop stitch. One of each matched pair was augmented with GraftJacket. Each construct was pre-loaded at 10 N and cyclically loaded (20 cycles) from 2 N to 30 N at a rate of 5 N/sec on an Instron machine. This was followed by testing to failure at a displacement rate of 6 mm/sec. Results: The ultimate failure load in the control group was 217 N ± 31 compared to 455 N ± 76.5 in the GraftJacket group ( p < 0.001). The mean stiffness in the control group was 4.3 ± 0.83 N/mm which was significantly less than the 12.99 ± 5.34 N/mm in the GraftJacket group ( p = 0.002). Conclusion: The augmentation of an Achilles tendon repair with GraftJacket significantly increased repair strength and stiffness. Clinical Significance: These findings suggest that a GraftJacket augmented Achilles tendon repair could acutely withstand a more aggressive rehabilitation program, potentially decreasing ankle stiffness and allowing earlier return to full activities.

scholarly journals Transverse versus longitudinal incision for minimally invasive Achilles tendon repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Daniel Bohl ◽  
Eric Barnard ◽  
Kamran Movassaghi ◽  
Kamran Hamid ◽  
Adam Schiff
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Suture Material ◽  
Tendon Repair ◽  
Wound Complications ◽  
Transverse Incision ◽  
Longitudinal Incision ◽  
Achilles Tendon Repair ◽  
Deep Suture ◽  
No Tourniquet

Category: Sports Introduction/Purpose: The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk. Methods: The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics. Results: Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds. Conclusion: The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.

The Effect of Obesity on Achilles Rupture Repair

2018 ◽  
Vol 12 (6) ◽  
pp. 503-512 ◽  
Author(s):  
Jeffery S. Hillam ◽  
Neil Mohile ◽  
Niall Smyth ◽  
Jonathan Kaplan ◽  
Amiethab Aiyer
Keyword(s):  
Achilles Tendon ◽  
Tendon Repair ◽  
Wound Dehiscence ◽  
Comorbid Conditions ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Achilles Tendon Repair ◽  
Increased Risk ◽  
American College Of Surgeons ◽  
Tendon Ruptures

Introduction. Obesity is an increasingly common comorbidity that may negatively affect outcomes following orthopaedic surgery. It is valuable to determine whether obese patients are vulnerable for postoperative complications. The purpose of this study was to analyze data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods. Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the ACS NSQIP. The patients were divided into 2 cohorts (obese and nonobese), then perioperative and postoperative factors were evaluated for association with obesity. Results. A total of 2128 patients were identified, of whom 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 versus 56.1 minutes. The only postoperative complication associated with obesity was wound dehiscence. Logistic regression adjusted for comorbid conditions demonstrated that obesity was not associated with an increased risk of wound dehiscence. Conclusion. A large segment of the patient population undergoing Achilles tendon repair is obese. Obesity was found to have an increased association with wound dehiscence, likely related to comorbid conditions, following Achilles tendon repair. Obesity was not significantly associated with any other complication. Levels of Evidence: III, Retrospective Cohort Study

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