A Cost Comparison of Digital Nerve Repair Techniques
Kevin G Hu, BA1, Mica CG Williams, B.S.2, Alexander J Kammien, BS1, Joseph K Canner, MHS2, Thayer Mukherjee, MD2 and David L Colen, MD2, 1Yale School of Medicine, New Haven, CT, 2Yale University School of Medicine, New Haven, CT
Background
Recent studies suggest cadaveric nerve allograft has equivalent outcomes compared to the gold standard autograft for treating short digital nerve gaps. We report the first direct cost comparison of various digital nerve injury reconstruction techniques and anticipate significant cost increases with use of allogenic implants.
Methods
The current study analyzed encounter-level data from the State Ambulatory Surgery and Services Database for Florida, New York, and Wisconsin from 2015-2020. Patients with primary repair, short autograft, conduit, and allograft without other surgeries were identified. Total charges, surgical supply charges, and operating room charges were compared.
Results
The study sample comprised 3,451 patients: 1,792 primary nerve repairs (51.9%), 60 autograft (1.7%), 1,356 conduit (39.3%), and 243 allograft (7.0%). 1,850 patients were male (53.6%) with mean age 40.3 ± 16 years. Procedure frequencies were significantly different between states (p < 0.001), with the greatest percentage of allografts performed in Florida (9.2%) compared to 6.4% in New York and 4.8% in Wisconsin. Procedure type was associated with ZIP code median household income quartile (ZIP-MHIQ; p < 0.001) and payer (p < 0.001). High ZIP-MHIQ, compared to low ZIP-MHIQ, had a higher percentage of primary repairs (56.6% vs 45.6%) and a lower percentage of allografts (5.8% vs 9.9%).
Across all three states, median total charges varied (p < 0.001) for each procedure, with the greatest median charges associated with allograft ($27,869), followed by autograft ($17,419), conduit ($16,254), and primary repair ($10,566). Median charges for surgical supplies was greatest for allograft ($9,154), followed by conduit ($3,540), autograft ($212.90), and primary repair ($0). Allograft was more expensive than all other methods with respect to total charges, supply charges, and operating room charges (p < 0.001). Analyzing each state separately, allograft was significantly more expensive than all other procedures with respect to total costs and supply costs (p < 0.01). There was no significant difference between allograft and autograft with respect to operating room charges in Florida (p = 0.13) and New York (p = 0.22). Medicare/Medicaid was the primary payer for 773 (22.4%) procedures, including 63 (26.0%) allografts, 17 (28.3%) autografts, and 340 (25.2%) conduits.
Conclusion
Nerve allograft is the most expensive method of digital nerve repair, most likely due to the cost of the implant. Surgeons should consider this cost along with operative factors and morbidity in their choice of digital nerve repair technique.
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