Speaker: Manipulation under anesthesia for adhesive capsulitis is expensive
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PHOENIX — A speaker at the Orthopaedic Research Society Annual Meeting said he and his colleagues recommend that only after trying all other conservative approaches to treat adhesive capsulitis of the shoulder should manipulation under anesthesia be performed, due to the poor economic profile of the procedure.
“Costs for performing this procedure far exceeded reimbursements, resulting in a substantial cost for patients treated operatively. So, the mean day of surgery cost was $20,000 vs. reimbursements of $4,500, resulting in a net loss of about $16,000,” Travis A. Doering, MD, said.
He noted most of the increased costs associated with manipulation under anesthesia (MUA) were due to anesthesia, OR time and the management of any complications.
Doering and colleagues studied about 18,000 women and 11,100 men in the Medicare Standard Analytical File from the PearlDiver database who underwent shoulder MUA between 2005 and 2015. They found women underwent MUA at a rate of 2:1 vs. men.
“The incidence of manipulation decreased during the study time period from a high of 3,200 cases in 2005 and then dropped to 2,400 [cases] in 2014, which is a 26% decrease,” Doering said.
The optimal treatment for adhesive capsulitis is controversial, he said. The costs associated with MUA make this “a cost-ineffective option for management of adhesive capsulitis,” Doering said.
Furthermore, randomized trials in which MUA was compared to physical therapy showed it offered no advantages to patients for treatment of adhesive capsulitis, he noted. – by Susan M. Rapp
Reference:
Chen YH, et al. Poster 520. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 8-11, 2020; Phoenix.
Disclosure: Doering reports no relevant financial disclosures.