Orthopedic Trauma Surgeons Achieve Shorter Operative Times and Lower Implant and Supply Costs Without Compromising Outcomes in Distal Radius ORIF at a Physician-Owned Ambulatory Surgery Center
DOI:
https://doi.org/10.55576/job.v6i3.91Keywords:
Distal Radius Fractures, Cost Analysis, Fellowship Training, Operative Efficiency, Value-Based CareAbstract
Objectives: As orthopedic care becomes increasingly specialized, the allocation of wrist fracture treatment must consider value-based care models. Depending on referral patterns, distal radius fractures are treated by trauma or hand fellowship trained physicians. Our objective is to compare operative time and direct costs between orthopedic trauma and hand fellowship-trained surgeons performing distal radius open reduction and internal fixation (ORIF) at a physician-owned ambulatory surgery center (ASC). Complication data were collected to enable clinical outcome comparison.
Design: Retrospective economic and clinical chart review.
Setting: Physician-owned ASC.
Patients/Participants: 411 patients underwent distal radius ORIF from January 2020 to September 2025.
Intervention: Distal radius ORIF stratified by surgeon fellowship training (hand versus orthopedic trauma).
Main Outcome Measurements: Primary: operative time (minutes) and total direct costs (implant and supply costs, USD). Secondary: nonunion, tendon rupture, unplanned hardware removal, and complex regional pain syndrome (CRPS).
Results: Trauma surgeons had significantly shorter operative times (median 36.5 min, interquartile range [IQR] 27.0–46.1) versus hand surgeons (43.5 min, IQR 33.0–63.3; p<0.001) and lower total costs (median $1,011 [IQR $845–$1,386] vs $2,347 [IQR $1,496–$2,782]; p<0.001). Complication rates were equivalent between groups (all p>0.05).
Conclusions: Orthopedic trauma surgeons perform distal radius ORIF faster and at lower cost than hand surgeons without any difference in complication rates. This finding has significant implications for improved contribution margin, lost opportunity cost, value-based care and ASC efficiency.
Level of Evidence: Level III – Retrospective Comparative Study
Key Words: Distal Radius Fractures; Cost Analysis; Fellowship Training; Operative Efficiency; Value-Based Care
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Copyright (c) 2026 Shreyas Mathiraj, Benjamin Vincze, Christopher Fernainy, Robert Heidel, Peter Althausen
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