Patient-Level Value Analysis for Operative Management of Distal Radius Fractures: Factors Affecting Value.

Abstract

Value-based care emphasizes outcomes achieved relative to cost in the delivery of surgical care. The purpose of this study was to evaluate factors influencing value within 3 months following operative management of distal radius fractures (DRFs). Patients aged > 18 years who underwent operative management with a volar locking plate of an isolated DRF between 2018 and 2021 at a single health system were eligible for inclusion. Patients were excluded if they underwent additional procedures on the affected hand/wrist within 3 months postoperatively. The Patient-Reported Wrist/Hand Evaluation (PRWHE) was collected at baseline and 3 months. Costs were calculated using time-driven activity-based costing (TDABC). Value was calculated as the change in PRWHE divided by total episode-of-care cost. In total, 125 patients were included (mean age 59.6 ± 13.7 years, 87.2% women). The PRWHE scores improved from 71.2 ± 19.8 at baseline to 19.6 ± 15.0 at 3 months. The mean total cost of care was $5258.43 ± $894.45. Baseline PRWHE demonstrated a strong positive correlation with value (<i>r</i> = .69, <i>P</i> < .001), while total cost (<i>r</i> = -.59), procedure duration (<i>r</i> = -.47), and implant cost (<i>r</i> = -.4) were negatively correlated with value (<i>P</i> < .001). Baseline PRWHE and total cost were independent predictors of value (<i>P</i> < .001). Higher baseline PRWHE scores and lower total cost were independently associated with higher value following operative management of DRFs. These findings support incorporating patient factors, fracture characteristics, and cost considerations into preoperative counseling and care planning to optimize value.