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Operative costs account for most expenses in shoulder arthroplasty
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Published results showed operative costs were associated with most short-term costs in shoulder arthroplasty.
“Most of the costs associated with shoulder arthroplasty occur in the operating room and most of the operating room costs are associated with the implant,” Peter N. Chalmers, MD, co-author of the study, told Healio.com/Orthopedics. “If we want to reduce cost with shoulder arthroplasty, we need to focus our efforts on this cost, as we have a limited ability to reduce costs with other portions of the patient’s care.”
Among 361 shoulder arthroplasties performed at a single facility between July 2011 and November 2016, Chalmers and colleagues collected patient factors, indications, procedure, complications and implant brand indicated as implant brand A, implant brand B and other. Researchers also used a validated internal tool to collect direct costs during a 90-day period. Multivariable generalized linear models were used to identify patient and procedure characteristics associated with costs.
Of the procedures performed, 19% were revision arthroplasty procedures, 32% were anatomic total shoulder arthroplasties and 66% were reverse total shoulder arthroplasties. Results showed operative facility utilization costs and operative supply costs were associated with 13% and 58% of the total costs, respectively. Researchers found younger age and an indication for surgery other than osteoarthritis, a failed arthroplasty or the sequelae of a rotator cuff tear were associated with increased total cost. Increased operative costs were also associated with younger age and the sequelae of a rotator cuff tear as an indication for surgery or an indication for surgery of other, according to results, as well as use of a reverse total shoulder arthroplasty, use of a bone graft, implant brand B and implant brands other than A and B.
“Future bundled payment models will need to include age and indication for surgery, as less common indications for surgery are definitely associated with higher costs,” Chalmers said. “Finally, bone graft use and reverse shoulder arthroplasty use are both associated with higher costs and going forward, we will need to consider these factors in our cost- benefit analyses.” – by Casey Tingle
Disclosures: Chalmers reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Thomas Quin Throckmorton, MD, FAAOS
This timely article from Robert Z. Tashjian, MD, and Peter N. Chalmers, MD, highlights the role of orthopedic surgeons in controlling costs in the current health care environment. More than ever, we are charged to be good stewards of the medical dollar, and this study nicely shows that most direct costs in shoulder replacement are operative.
The minority of these operative costs involve facility utilization expenditures. The majority, however, are operative supply costs. Of these, the use of bone graft as well as implant type and brand, are modifiable and typically under the surgeon’s control.
Many bundled care initiatives task the surgeon with the responsibility for cost containment, and, therefore, profitability of the program. This data is therefore very useful in understanding and leveraging potential areas of cost reduction in shoulder arthroplasty.
Residency Program Director
Department of orthopedic surgery
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