title: Effect of facility on the operative costs of distal radius fractures.
abstract: OBJECTIVE
  The purpose of this study was to investigate whether ambulatory surgery centers can deliver lower-cost care and to identify sources of those cost savings.
  
  
  METHODS
  We performed a cost identification analysis of outpatient volar plating for closed distal radius fractures at a single academic medical center. Multiple costs and time measures were taken from an internal database of 130 consecutive patients and were compared by venue of treatment, either an inpatient facility or an ambulatory, stand-alone surgery facility. The relationships between total cost and operative time and multiple variables, including fracture severity, patient age, gender, comorbidities, use of bone graft, concurrent carpal tunnel release, and surgeon experience, were examined, using multivariate analysis and regression modeling to identify other cost drivers or explanatory variables.
  
  
  RESULTS
  The mean operative cost was considerably greater at the inpatient facility ($7,640) than at the outpatient facility ($5,220). Cost drivers of this difference were anesthesia services, post-anesthesia care unit, and operating room costs. Total surgical time, nursing time, set-up, and operative times were 33%, 109%, 105%, and 35% longer, respectively, at the inpatient facility. There was no significant difference between facilities for the additional variables, and none of those variables independently affected cost or operative time.
  
  
  CONCLUSIONS
  The only predictor of cost and time was facility type. This study supports the use of ambulatory stand-alone surgical facilities to achieve efficient resource utilization in the operative treatment of distal radius fractures. We also identified several specific costs and time measurements that differed between facilities, which can serve as potential targets for tertiary facilities to improve utilization.
  
  
  METHODS
  Economic and Decisional Analysis III.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA. mathe016@mc.duke.edu
authors.forename: Richard C
authors.initials: RC
authors.lastname: Mather
authors.forename: Robert W
authors.initials: RW
authors.lastname: Wysocki
authors.forename: J
authors.initials: J
authors.lastname: Mack Aldridge
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: James A
authors.initials: JA
authors.lastname: Nunley
mesh_terms: D000046:Academic Medical Centers; D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000379:methods; D000704:Analysis of Variance; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics / Q000379:methods; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery