The primary cost drivers of arthroscopic rotator cuff repair surgery: a cost-minimization analysis of 40,618 cases

Li, Lambert; Bokshan, Steven L.; Ready, Lauren V.; Owens, Brett D.

doi:10.1016/j.jse.2019.03.004

Cited by 56 publications

(47 citation statements)

References 20 publications

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“…However, there is a growing body of literature seeking to identify important modifiable factors that drive higher costs in common arthroscopic procedures, such as anterior cruciate ligament reconstruction and rotator cuff repair. 5,9,13,15,22 Similar to the present study, these were not cost-utility or cost-effectiveness analyses. Nevertheless, as with the present study, these studies increase physicians’ awareness of the modifiable primary drivers of procedure costs—in this case, implant costs and surgical setting.…”

Section: Discussionmentioning

confidence: 53%

“…With the advent of bundled payments, there is a growing body of literature analyzing the health care expenditures of common arthroscopic procedures. 5,8,13,15,23 Specifically, many recent studies have focused on the patient-related and surgical factors that drive health care expenditures in common arthroscopic procedures. 5,8,13,15,23 The few published studies on anterior instability to date have leveraged billing charges and modeling methods in the performance of cost studies.…”

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confidence: 99%

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A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft

Uffmann

Christensen

Yoo

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: The optimal surgical treatment of anterior shoulder instability remains controversial. Hypothesis: (1) Implants and facility-related costs are the primary drivers of variation in direct costs between arthroscopic Bankart and Latarjet procedures, and (2) distal tibial allograft (DTA) is more costly than Latarjet as a function of the graft expense. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Intraoperative cost data were derived for all arthroscopic anterior stabilizations and Latarjet and DTA procedures performed at a single academic institution from January 2012 to September 2017. Cost comparisons were made between those undergoing arthroscopic stabilization and Latarjet and between Latarjet and DTA. Multivariate regressions were performed to determine the difference in direct costs accounting for various patient- and surgery-related factors. Results: A total of 87 arthroscopic stabilizations, 44 Latarjet procedures, and 5 DTA procedures were performed during the study period. Arthroscopic Bankart repair was found to be 17% more costly than Latarjet, with suture anchor implant cost being the primary driver of cost. DTA was 2.9-fold more costly than Latarjet, with greater costs across all domains. Multivariate analysis also found the number of prior arthroscopic procedures performed ( P = .007) and whether the procedure was performed in an ambulatory or inpatient setting ( P < .0001) to be significantly associated with higher direct costs. Conclusion: Latarjet is less costly than arthroscopic Bankart repair, largely because of implant cost. Value-driven strategies to narrow the cost differential could focus on performing these procedures in an outpatient setting in addition to reducing overall implant cost for arthroscopic procedures. Perceived potential benefits of DTA over Latarjet may be outweighed by higher costs.

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Section: Discussionmentioning

confidence: 53%

mentioning

confidence: 99%

A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft

Uffmann

Christensen

Yoo

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Previous research has shown that an increased number of anchors are associated with higher direct costs. 6,17 By avoiding the use of an additional implant, this technique can help mitigate some of the added costs associated with shoulder surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of an All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair

Meghpara

Schulz

Buerba

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Pathology of the long head of the biceps tendon frequently occurs concomitantly with rotator cuff tears, necessitating a surgical treatment, often in the form of a tenodesis procedure. Many techniques for a tenodesis exist; however, they often require additional implants or a separate incision. Purpose: To report an average of 2-year outcomes of an all-arthroscopic biceps tenodesis employing the stay sutures from the anterolateral anchor during concomitant double-row rotator cuff repair (RCR). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed for all patients who underwent an all-arthroscopic biceps tenodesis during concomitant double-row RCR by the senior author between January 2014 and May 2018. Patients were included if they underwent this procedure and had baseline preoperative patient-reported outcomes (PROs) with a minimum of 1 year of postoperative PROs for the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) for pain score. Additionally, patient data, surgical history, postoperative complications, and satisfaction were reported. Results: Fifteen patients were eligible for the study. There were 12 (80%) men and 3 (20%) women with a mean age of 50.0 years (range, 35-64 years). The mean follow-up time was 25.2 months (range, 13-63 months). Six of 15 (40%) patients also had an arthroscopic subscapularis repair performed. ASES shoulder scores improved from 37.1 preoperatively to 94.1 postoperatively ( P < .001), and VAS scores improved from 6.4 preoperatively to 0.5 postoperatively ( P < .001). One patient who underwent concomitant subscapularis repair reported continued anterior groove pain. No patients experienced biceps cramping, developed a deformity, or required a repeat operation at the final follow-up. Overall, 93.3% of the patients reported being highly satisfied with their surgery. Conclusion: This study presents the clinical results of an all-arthroscopic technique for concomitant double-row RCR and biceps tenodesis, which resulted in high rates of patient satisfaction and significant improvement in reported shoulder outcome and pain scores. Additionally, this technique offers the potential benefits of avoiding a secondary incision, which may decrease surgical morbidity while also decreasing cost by eliminating the need for an extra, tenodesis-specific implant.

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“…Moreover, patient complexity such as high body mass index and systemic illnesses increased the facility costs. Relatedly, Li et al 4 performed a database study to evaluate the primary cost drivers of arthroscopic rotator cuff repair. They found added cost owing to various factors including patient comorbidity, Medicare insurance, operative time, number of anchors, distal clavicle excision, subacromial decompression, and regional anesthesia.…”

Section: See Related Article On Page 2354mentioning

confidence: 99%

Editorial Commentary: Stagnant Surgeon Reimbursement Since 2005 Does Not Reflect the Current Complexity of Arthroscopic Rotator Cuff Repair in 2020

Gamradt

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The primary cost drivers of arthroscopic rotator cuff repair surgery: a cost-minimization analysis of 40,618 cases

Cited by 56 publications

References 20 publications

A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft

A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft

Clinical Outcomes of an All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair

Editorial Commentary: Stagnant Surgeon Reimbursement Since 2005 Does Not Reflect the Current Complexity of Arthroscopic Rotator Cuff Repair in 2020

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