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AN EXPLORATION OF ACL RECONSTRUCTION COSTS AND SOCIAL DETERMINANTS OF HEALTH

Abstract

Johanna M. Hoch, Rachel Hogg-Graham. University of Kentucky, Lexington, KY.

Background:Recent investigations have turned their attention to outcomes associated with various social determinants of health (SDOH) such as race, ethnicity, income and payor in patients that undergo ACL reconstruction (ACLR). It is imperative that we examine relevant SDOH in relation to ACLR costs and procedures to develop meaningful policies or procedures that address inequities in post-surgical outcomes. Therefore, this study examined the relationships between patient SDOH characteristics, costs, and number of in-scope procedures associated with ACLR encounter data from the Nationwide Ambulatory Surgery Sample (NASS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Methods:Data from the 2019 NASS and IRB approval were obtained. Patient encounters with a diagnosis code for ACL sprain and CPT code for ACLR, along with all SDOH variables were included (n=57,666). The total charges, number of concomitant in-scope procedures performed, and SDOH variables (race and ethnicity and expected primary payor) were explored. Descriptive statistics were calculated, and chi-square tests and separate analyses of variance were performed. Results:The average total charges for the included patient encounters was $41,572.38±$24,444.13. The average number of CPT codes was 1.8 (range 1-13). Almost 75% of the patients were privately insured (n=41,052). Patients with private insurance had less (1.78±0.77) in-scope CPT codes compared to patients with Medicaid (1.84±0.83, p<0.001) and patients with “other” as their expected payor (1.87±0.82, p<0.001). Patients of white race were more likely to have private insurance and non-white patients were more likely to have Medicaid (p<0.001). White patients had significantly lower total charges compared to non-white patients (p<0.001), and patients with private insurance had lower total charges than patients with Medicaid insurance (p<0.001). Conclusions: Patients of non-white race had more additional surgical procedures performed, were more likely to have Medicaid insurance, and had higher total charges. The literature suggests that these patients are more likely to have poor outcomes than white patients or patients with private insurance. Future research should continue to identify these relationships in post-operative outcomes to support policies to address post-outcome inequities in patient care.

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