Surgical repair of the ruptured Achilles tendon: the cost-effectiveness of open versus percutaneous repair
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- Carmont, M.R., Heaver, C., Pradhan, A. et al. Knee Surg Sports Traumatol Arthrosc (2013) 21: 1361. doi:10.1007/s00167-013-2423-1
Recent meta-analyses have shown reduced re-rupture rates for the surgical management of Achilles ruptures. However, percutaneous repair has been demonstrated to lead to improved function and patient satisfaction but greater complications than open repair. In the current economic climate, it is reasonable to consider the financial cost of rupture management for both the patient and the provider. The cost-effectiveness of operative treatment of ruptures of the Achilles tendon was determined based upon theatre occupancy, clinic attendance and cast changes, operative complications and functional assessment score.
The cost-effectiveness of the surgical management of Achilles tendon ruptures between 2005 and 2011 in our unit was audited by comparing 49 patients receiving percutaneous repair to 35 patients whom had open repairs.
There was no significant difference in complications between the two surgical techniques: (Open vs. Percutaneous) overall rates 14.3 versus 10.4 %: infection; 2.7 versus 2.0 %, transient sural nerve damage: 5.6 versus 8.1 %, wound breakdown: 2.8 versus 0.0 %, re-rupture: 2.8 versus 2.0 %. Achilles Total Rupture Scores (ATRS) were comparable [Open 89 (65–100) at 49 months vs. Percutaneous 88.8 (33–100) at 12 months (n.s.)]. Theatre occupancy (P < 0.00) and hospital stay (P < 0.00) were significantly longer with open repair [43 min (26–70) and 2.9 days (0–4)] compared to percutaneous repair [15 min (12–43) and 1.2 days (0–2)]. Excluding the costs of running the operating theatre, we have estimated the costs of surgery for open repair to be £935 and percutaneous repair to be £574.
This study suggests that percutaneous repair of the Achilles tendon resulted in reduced costs and yet had comparable outcome and complications rates to open repair in surgical management of the Achilles tendon. Percutaneous repair should be considered as the primary method of cost-effective surgical management of Achilles tendon rupture.
Level of evidence
A retrospective cohort study, Level III.