Procedural factors drive operative costs in arthroscopic rotator cuff repair
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Published results showed procedural factors were the most significant drivers of operative costs in arthroscopic rotator cuff repair, while no correlation was found with patient-level factors besides lower charges with women.
Greg L. Cvetanovich, MD, and colleagues collected patient- and procedure-level factors among 712 patients who underwent arthroscopic rotator cuff repair between November 2016 and July 2019 at an ASC to identify intraoperative drivers of cost. Researchers analyzed age, sex, insurance type, American Society of Anesthesiologists grade and Charlson comorbidity index as patient-level factors, while procedure-level factors included use of biologics, anesthesia type, number of anchors and sutures, additional procedures and operative time. Researchers used multivariate linear regression analysis to identify factors significantly associated with higher or lower charges.
Researchers found risk-adjusted operative charges of $19,728, with the factors included predicting nearly 65% of the variability in operative charges. Results showed female sex was the only patient-level factor significantly associated with lower charges. Use of biologics, concurrent open biceps tenodesis, distal clavicle resection, use of regional block, number of anchors and increased operative time were procedure-level factors significantly associated with higher charges, according to results. Researchers noted other factors had no significant association.
“With the increasing focus on evidence-based and value-based medicine, it is important for surgeons performing rotator cuff repairs to consider when these more expensive interventions are necessary to achieve the best patient outcomes and balance these with increased operative cost,” Cvetanovich told Healio Orthopedics. “Furthermore, research should continue to investigate how these interventions impact clinical outcomes, rotator cuff repair healing rates and cost-effectiveness of emerging biologic augmentation techniques.”
Perspective
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The U.S. spends the most on health care in the world, and health care expenses are expected to rise to 20% of gross domestic product by 2025. Such expenses have led to an increasing emphasis on cost savings. In this study out of Ohio State University, Jesse H. Morris, MD, and colleagues reviewed the costs of 712 arthroscopic rotator cuff repairs at their ASC. The mean risk-adjusted charges were $19,728 per arthroscopic rotator cuff repair. Procedural-related factors, particularly implants, were the largest drivers of cost which increased by $26 per minute of operative time, $2,245 per anchor, $4,027 with the addition of an open biceps tenodesis and $17,791 with the addition of biologics. The latter stands out the most given the interest in using biologics to promote healing. The weak link in arthroscopic rotator cuff repair has become healing with many tears failing to heal, particularly large tears and those with associated fatty degeneration. Biologic augmentation may be the next frontier in optimizing outcomes. However, as we move into a value-based care model, ongoing research will clearly be required to justify the increase. Will the added time and cost of the procedures produce cost savings in the end and improve quality of life? Time will tell. At the same time, there are more forces at play than surgeons wanting their patients to heal. In the U.S., we are accustomed to having the newest technology available and patients often request biologic augmentation. Increasing insurance costs (both for employees and malpractice) and overhead expenses undoubtedly push the surgeon drive for volume. Lastly, costs at ASCs are approximately 40% of the same procedure performed in a hospital. Thus, the largest driver of cost may be external factors and surgery location.
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