前交叉韧带重建的患者层面价值分析：2年诊疗周期中的实践应用
简介
将患者层面价值分析（PLVA）用于初次ACL重建的2年诊疗周期，纳入491例患者，以KOOS变化与TDABC总费用之比（VKOOS）衡量价值。总费用与2年KOOS、SANE变化相关性差；手术时间、合并半月板修复、移植物类型和植入物影响价值，同种异体移植物VKOOS低于自体移植物。提示ACLR费用增加未改善疗效，移植物选择等成本效益因素值得关注。
英文摘要
BACKGROUND: Patient-level value analysis (PLVA) demonstrates promise in measuring value, or outcomes achieved per dollar spent, of interventions such as orthopedic sport surgeries. Despite prior applications, PLVA has never been implemented in anterior cruciate ligament (ACL) reconstruction (ACLR). The purpose of this study was to apply PLVA in the setting of an ACLR 2-year episode of care and identify factors that influence value. MATERIALS AND METHODS: The patient-reported outcome measure (PROM) database of an ambulatory surgical center was queried for ACLR procedures from 2009 to 2022. Any procedure that was not a unilateral single-ligament primary ACLR for acute ACL injury (<6 months) or that lacked PROM data was excluded. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Single Assessment Numerical Evaluation (SANE) were used. Costs of care were quantified using time-driven activity-based costing (TDABC), adjusting for 2024 US dollars. Primary outcome of interest was 2-year value quotient, the ratio of 2-year change in KOOS to the TDABC total costs of care (VKOOS). RESULTS: In total, 491 patients and 24 surgeons were analyzed. Total costs of care correlated poorly with 2-year change in KOOS (r = 0.14) and SANE (r = 0.13). Factors associated with 2-year value included operative time, concomitant meniscal repair, graft type, and implants (all P ≤ .038). Allograft ACLR exhibited lower VKOOS (P = .003) compared to autografts. CONCLUSION: PLVA quantified 2-year value and identified influential institutional factors in the context of primary ACLR. Increased costs of care did not achieve improved outcomes. This methodology should be further implemented and researched in orthopedics.