Sick leave and return to work after surgery for type II SLAP lesions of the shoulder: a secondary analysis of a randomised sham-controlled study

Brox, Jens Ivar; Skare, Øystein; Mowinckel, Petter; Brox, Jostein Skranes; Reikerås, Olav; Schrøder, Cecilie Piene

doi:10.1136/bmjopen-2019-035259

Cited by 9 publications

(9 citation statements)

References 46 publications

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“…With regard to work, an assessment of missed work after SLAP tears performed at a single institution in Norway determined that patients treated with biceps tenodesis missed more days of work in the first 6 months and one year postoperatively than those who underwent sham surgery or SLAP repair, However, these differences were not significant after adjusting for preoperative absenteeism. 3 Examining the treatment of SLAP tears in an active-duty military population offers insight into the occupational impact of both procedures. In this younger population that is required to meet physical performance standards, biceps tenodesis was associated with equivalent or higher rates of return to military duty as well as equivalent or lower rates of medical discharge.…”

Section: Discussionmentioning

confidence: 99%

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Sandler

Childs

Dunn

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. Hypothesis: In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. Results: Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. Conclusion: In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.

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Section: Discussionmentioning

confidence: 99%

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Sandler

Childs

Dunn

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…In comparison in our cohort, only 49% of patients reported symptoms for more than a year prior to surgery. In addition to the differing demographics, our dichotomous analysis of duration of symptoms prior to surgery varied to the study performed by Brox et al 24 Brox et al compared more than one year of symptoms prior to surgery and less than one year, while we compared more than six months and less than six months. 24 These differences may account for the contrasting results.…”

Section: Discussionmentioning

confidence: 99%

Is timing of superior labrum anterior to posterior (SLAP) repair important? A cohort study evaluating the effect of the duration of symptoms prior to surgery on the outcomes of patients who underwent type II SLAP repair

2021

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Background The management of superior labrum anterior to posterior (SLAP) tears is somewhat controversial. It is unclear if the length of time between symptom onset and surgery affects SLAP repair outcomes. Methods Sixty-one SLAP repairs were retrospectively reviewed pre-operatively and post-operatively at 1, 6, 24 weeks, and > 2 years post-surgery. Patients were allocated to an ‘early repair’ or ‘late repair’ group based on time between symptom onset and surgery. Results Of the 61 patients, 22 patients had surgery within six months of symptom onset. Pre-operatively, ‘late repair’ patients played a higher level of sport than ‘early repair’ patients prior to injury. Post-operatively, both groups had similar outcomes up to six months, though at six months ‘early repair’ patients reported a higher level of work than ‘late repair’ patients (p = 0.01). At > 2 years after surgery, ‘early repair’ patients had reduced pain and difficulty with overhead activities (p = 0.002), less stiffness (p = 0.001) and were more satisfied than ‘late repair’ patients (p = 0.04). Conclusions Up to six months post-operatively, the time between symptom onset and surgery has limited effect on functional outcomes. However, at > 2 years after surgery, earlier repairs ( < 6 months) are interestingly associated with better functional outcomes. Further studies are required to determine if this is a causal relationship.

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“…Both total and shoulder specific work absence will be analysed using patient reported and registry data. 35 Direct and indirect costs are compared for intervention and TAU groups, respectively. In addition, based on the same costs, a CUA will be performed where the costs per quality-adjusted life-years are compared for the two options.…”

Section: Methods and Analysesmentioning

confidence: 99%

Making shoulder pain simple in general practice: implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study)

Ekeberg¹,

Pedersen

Natvig

et al. 2022

BMJ Open

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IntroductionResearch suggests that current care for shoulder pain is not in line with the best available evidence. This project aims to assess the effectiveness, cost-effectiveness and the implementation of an evidence-based guideline for shoulder pain in general practice in Norway.Methods and analysisA stepped-wedge, cluster-randomised trial with a hybrid design assessing clinical effectiveness, cost-effectiveness and the effect of the implementation strategy of a guideline-based intervention in general practice. We will recruit at least 36 general practitioners (GPs) and randomise the time of cross-over from treatment as usual to the implemented intervention. The intervention includes an educational outreach visit to the GPs, a computerised decision tool for GPs and a self-management application for patients. We will measure outcomes at patient and GP levels using self-report questionnaires, focus group interviews and register based data. The primary outcome measure is the patient-reported Shoulder Pain and Disability Index measured at 12 weeks. Secondary outcomes include the EuroQol Quality of Life Measure (EQ5D-5L), direct and indirect costs, patient’s global perceived effect of treatment outcome, Pain Self-Efficacy and Brief Illness Perception Questionnaire. We will evaluate the implementation process with focus on adherence to guideline treatment. We will do a cost–minimisation analysis based on direct and selected indirect costs and a cost–utility analysis based on EQ5D-5L. We will use mixed effect models to analyse primary and secondary outcomes.Ethics and disseminationEthics approval was granted by the Regional Committee for Medical and Health Research Ethics-South East Norway (ref. no: 2019/104). Trial results will be submitted for publication in a peer-reviewed medical journal in accordance with Consolidated Standards of Reporting Trials.Trial registration numberNCT04806191.

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Sick leave and return to work after surgery for type II SLAP lesions of the shoulder: a secondary analysis of a randomised sham-controlled study

Cited by 9 publications

References 46 publications

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Is timing of superior labrum anterior to posterior (SLAP) repair important? A cohort study evaluating the effect of the duration of symptoms prior to surgery on the outcomes of patients who underwent type II SLAP repair

Making shoulder pain simple in general practice: implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study)

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