Value-Based Care: Cost Savings with Amino Acid Supplementation in Orthopaedics

Value-Based Care: Cost Savings with Amino Acid Supplementation in Orthopaedics

The pursuit of better outcomes and cost-effectiveness is driving advancements in orthopaedic surgery. Recent innovations in postoperative care, such as amino acid supplementation, are significantly reshaping the field. This is a novel approach for most surgeons who have traditionally focused on implant design and surgical technique advancements to improve outcomes. Nutritional optimization as an emerging concept is gaining traction as it’s addressing a long overlooked variable in surgical perioperative care.  

By improving a patient’s nutritional status and providing the essential nutrients necessary during the most critical time of surgical recovery, clinical applications lead to reduced postoperative complications. This methodology aligns with the principles of value-based care by delivering substantial cost savings. In this article, we examine research by Shafrin et al. that highlights the transformative potential of amino acid supplementation in orthopaedic recovery.

The Cost Savings Imperative

Orthopaedic surgeons have long grappled with the substantial economic burden posed by postoperative complications. These complications not only hinder patients' recovery but also exert tremendous strain on healthcare resources. Recognizing this challenge, Shafrin et al. conducted a Level 1 Economic Study to explore the economic impact of amino acid supplementation in orthopaedic postoperative care.

Their findings underscore a clear advantage for amino acid supplementation:

  • Cost Reductions: Incorporating conditionally essential amino acids (CEAA) alongside standard care led to an impressive average cost reduction of $4,902 per patient. This substantial economic benefit underscores the potential of amino acid supplementation as a cost-effective intervention.
  • Value-Based Care Alignment: Embracing CEAA aligns seamlessly with the healthcare industry's shift towards value-based care. By enhancing outcomes while optimizing costs, it promises an overall superior healthcare experience for patients. 

Embracing Nutritional Optimization

Orthopaedic perioperative care is on the brink of transformation, and nutritional optimization, particularly through amino acid supplementation, is taking a leading role:

  • Standard of Care: Accumulating evidence positions nutritional optimization, including CEAA found in Xcelerated Recovery, as an emerging standard practice in orthopaedic care. Its benefits in expediting recovery and reducing complications are compelling. This supplement contains necessary CEAA and key substrates promoting collagen, bone, and muscle protein synthesis.

The Economic Impact and Value

When projecting the impact of CEAA supplementation on the broader population of patients requiring fracture fixations in trauma centers, the results are staggering:

  • Monetary Benefit: CEAA use, when compared to no CEAA, amounted to an impressive $316 million. This equates to an increase of 813 Quality-Adjusted Life Years (QALYs) annually, translating to a gain of 0.013 QALYs per person valued at $150,000. Additionally, there's an incremental cost savings of $4,902 per patient, resulting in a net monetary benefit of $6,852.
  • Cost-Effectiveness: This Level 1 Economic Study's findings reveal that the use of CEAA, like those found in Xcelerated Recovery, outperformed standard care. It solidifies its dominance in terms of both economic and clinical benefits.

The Pivot Towards Value-Based Care

In an era where healthcare is rapidly pivoting towards value-based care, interventions like perioperative amino acid supplementation are pivotal. 

Clinical and Economic Benefits: These interventions not only offer clinical advantages but also align with cost-effective strategies. The adoption of nutritional optimization, including amino acid supplementation, signifies more than a medical intervention; it's a paradigm shift towards enhanced recovery and cost-effective healthcare practices.

Orthopaedic surgeons are continually seeking innovative ways to enhance patient outcomes and control costs in the value-based healthcare landscape.  Nutritional status is being recognized as a significant modifiable risk factor that can be positively impacted during the perioperative episode.  Shafrin et al.'s Level 1 Economic Study demonstrates that amino acid supplementation offers a practical approach to achieving these goals. By reducing postoperative complications and generating substantial cost savings, amino acid supplementation is positioning itself as a cornerstone of value-based orthopaedic care.

Healthcare providers, professional associations, and healthcare systems should evaluate the value of CEAA use as part of surgical recovery protocols, including Enhanced Recovery After Surgery (ERAS) guidelines. Integrating CEAA supplementation into orthopaedic perioperative protocols can reduce overall costs and complications, aligning with the focus on treatment value linked to both quality of care and cost. It's a step towards more efficient and effective healthcare that benefits patients and healthcare systems alike.

The question that remains is: How will we and our organizations implement nutritional optimization in orthopaedic care? The answer may very well reflect the quality of care we provide to our patients.

Shafrin J, Than KS, Kanotra A, Kerr KW, Robinson KN, Willey MC. Use of Conditionally Essential Amino Acids and the Economic Burden of Postoperative Complications After Fracture Fixation: Results from a Cost Utility Analysis. Clinicoecon Outcomes Res. 2023 Oct 25;15:753-764. doi: 10.2147/CEOR.S408873. PMID: 37904809; PMCID: PMC10613425.

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