Arthroscopic Bankart repair more cost effective than open surgery

Reducing the cost of postoperative hospitalization could cut the overall costs associated with open Bankart repairs.

Arthroscopically treating patients with recurrent shoulder instability may result in lower overall costs compared to open Bankart repairs, a retrospective study suggests.

Conrad Wang, MD, and colleagues at the Massachusetts General Hospital in Boston and at Loma Linda University in Loma Linda, Calif., found that the costs associated with hospitalizing patients overnight following open Bankart repair resulted in significantly higher overall charges. However, because arthroscopic procedures had significantly higher equipment costs, the difference between the two procedures would be negligible if both were performed on an outpatient bases, according to the study.

Wang and colleagues reviewed the medical records and billing information for 41 patients (42 shoulders) treated for recurrent shoulder instability. Twenty-two shoulders (21 patients) underwent open surgery and 20 shoulders (20 patients) received arthroscopic surgery.

Two surgeons performed all procedures; one performed only open Bankart repairs and one performed only arthroscopic repairs. There was a significant difference in mean age between treatment groups, the authors noted. Open surgery patients had a mean age of 23 ± 8 years while arthroscopically treated patients had a mean age of 35 ± 14 years (P<.05), according to the study.

Open Bankart repairs were performed using three nonabsorbable braided polyester sutures with the patient under general anesthesia. Postoperatively, patients were admitted for observation overnight and released the following day.

For arthroscopic repairs, the surgeon used interscalene anesthesia and supplemental general anesthesia, if required. The surgeon completed the repairs using one absorbable anchor (Panalok, Mitek/Johnson & Johnson) and two nonabsorbable metal anchors (Knotless, Mitek/Johnson & Johnson). Patients were discharged the day of surgery.

The researchers found that open procedures had significantly higher operating times and total OR times as well as significantly greater total charges. “However, OR equipment charges were significantly greater for arthroscopic procedures, which resulted in greater OR charges for arthroscopic cases,” the study authors said.

Equipment charges averaged $56 ± 100 for open repairs compared with $1083 ± 424 for arthroscopic repairs.

“Despite this difference in equipment charges, overall charges for open Bankart procedures were significantly greater than those for arthroscopic Bankart procedures. This was the result of the additional cost of postoperative inpatient recovery for those undergoing the open procedure,” they said.

Operating times averaged 104 ± 21 minutes for open procedures compared with 75 ± 15 minutes for arthroscopic procedures (P<.001). Total OR time averaged 133 ± 26 minutes for open procedures compared with 110 ± 22 minutes for arthroscopic procedures (P<.005). Total charges averaged $8481 ± 1026 for open procedures compared with $6704 ± 1315 for arthroscopic procedures (P<.001), according to the study.

Both procedures had similar anesthesia and OR service charges. Both groups also had similar postop American Shoulder and Elbow Surgeons shoulder and pain scores, the authors noted.

For more information:
Wang C, Ghalambor N, Zarins B, Warner JJP. Arthroscopic versus open Bankart repair: Analysis of patient subjective outcome and cost. Arthroscopy. 2005;21:1219-1222.