OBJECTIVES: By integrating postoperative patient-reported outcome measures (PROMs) with time-driven activity-based costing, this study aims to (1) quantify variations in the value of hip arthroscopy (HA) for acetabular labral repair and (2) explore patient-level characteristics (e.g., demographics, comorbidities, preoperative PROMs, and intraoperative variables) that may contribute to this variation.

METHODS: Using a single surgeon database, we identified 161 patients undergoing outpatient primary HA for labral repair between 2015-2020 with minimum 2-year follow-up. To calculate patient value, 2-year postoperative International Hip Outcome Tool-33 (iHOT-33) scores were divided by time-driven activity-based costs and multiplied by a constant to set the study average to 100. Multivariable linear mixed-effects models were employed to identify factors underlying variation in value.

RESULTS: Variation in HA value ranged from 25.4 to 216.4 (mean ± standard deviation: 100 ± 38.4), with a 3.0-fold variation in value between patients in the 10^th and 90^th percentile. Higher value was significantly associated with Tönnis grade 0 (12.2-point increase, p=0.025), no prior contralateral hip arthroscopy (17.3-point increase, p=0.039), higher preoperative PROMs (0.52-point increase per 1-unit increase, p<0.001), and no bone marrow aspirate concentrate or microfracture (33.8-point increase, p<0.001). Variation in value was also significantly associated with osteoplasty type and labral treatment technique (p<0.05 for both). In contrast, operative year, age, gender, body mass index, race, ethnicity, Outerbridge grade, and American Society of Anesthesiologists score were not independently associated with value. A model incorporating these factors as fixed effects and the surgery center as a random effect explained 42.3% of the observed variation in value.

CONCLUSIONS: This study demonstrated wide variation in the value of hip arthroscopy that was mostly strongly associated with procedure type and preoperative PROMs, while patient demographics contributed minimal independent variability. These findings may promote optimization of the hip arthroscopy care pathway to reduce variation and deliver higher-value care.