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Cost Drivers Associated With Anterior Shoulder Stabilization Surgery.
Orthop J Sports Med. 2020 Jun; 8(6):2325967120926465.OJ

Abstract

Background

Arthroscopic Bankart repair, open Bankart repair, and the Latarjet procedure are common treatments for anterior shoulder instability; however, little is known of costs by patient- and surgeon-specific factors. This study aimed to identify areas where cost reduction may be achieved.

Hypothesis

Increased total charges will be associated with low-volume surgeons and surgical facilities, hospital-owned facilities, open surgical techniques, and patients with at least 1 comorbidity.

Study Design

Economic and decision analysis; Level of evidence, 3.

Methods

The 2014 State Ambulatory Surgery and Services Databases from 6 states were utilized. There were 3 Current Procedural Terminology codes (23455, 23462, 29806) used to identify open Bankart repair, the Latarjet procedure, and arthroscopic Bankart repair, respectively. Patient demographic and surgical variables were evaluated on a univariate basis, and all significant factors were then included in the multiple linear regression to determine which factors had the largest effect on cost. Total charges billed for the encounter were used as a proxy for cost of surgery.

Results

For open Bankart repair, arthroscopic Bankart repair, and the Latarjet procedure, longer operative times increased costs, and high-volume surgical facilities had decreased charges. For the arthroscopic Bankart group, additional factors that increased charges included postoperative hospital admission (US$11,516; P < .001), patient residence in a ZIP code with a below-median income (US$2909; P < .001), presence of a comorbidity (US$1982; P < .001), male sex (US$1545; P = .003), Hispanic race (US$2493; P = .005), and use of regional anesthesia (US$1898; P = .025). Additional cost drivers for the Latarjet procedure included postoperative hospital admission (US$7028; P = .022) and older age (US$187/y; P = .039).

Conclusion

Postoperative admission to the hospital was the largest cost driver for arthroscopic Bankart repair and the Latarjet procedure. Low-volume facilities were the largest cost driver for open Bankart repair. High-volume surgery centers had lower costs when compared with low-volume surgery centers. Regional anesthesia increased costs in the arthroscopic Bankart group. These findings may help to show where cost savings can be achieved, particularly considering increasing trends toward bundled health care payments.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32613022

Citation

Li, Lambert T., et al. "Cost Drivers Associated With Anterior Shoulder Stabilization Surgery." Orthopaedic Journal of Sports Medicine, vol. 8, no. 6, 2020, p. 2325967120926465.
Li LT, Bokshan SL, Levins JG, et al. Cost Drivers Associated With Anterior Shoulder Stabilization Surgery. Orthop J Sports Med. 2020;8(6):2325967120926465.
Li, L. T., Bokshan, S. L., Levins, J. G., & Owens, B. D. (2020). Cost Drivers Associated With Anterior Shoulder Stabilization Surgery. Orthopaedic Journal of Sports Medicine, 8(6), 2325967120926465. https://doi.org/10.1177/2325967120926465
Li LT, et al. Cost Drivers Associated With Anterior Shoulder Stabilization Surgery. Orthop J Sports Med. 2020;8(6):2325967120926465. PubMed PMID: 32613022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost Drivers Associated With Anterior Shoulder Stabilization Surgery. AU - Li,Lambert T, AU - Bokshan,Steven L, AU - Levins,James G, AU - Owens,Brett D, Y1 - 2020/06/22/ PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline KW - economic and decision analysis KW - general sports trauma KW - glenoid labrum KW - shoulder instability SP - 2325967120926465 EP - 2325967120926465 JF - Orthopaedic journal of sports medicine JO - Orthop J Sports Med VL - 8 IS - 6 N2 - Background: Arthroscopic Bankart repair, open Bankart repair, and the Latarjet procedure are common treatments for anterior shoulder instability; however, little is known of costs by patient- and surgeon-specific factors. This study aimed to identify areas where cost reduction may be achieved. Hypothesis: Increased total charges will be associated with low-volume surgeons and surgical facilities, hospital-owned facilities, open surgical techniques, and patients with at least 1 comorbidity. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The 2014 State Ambulatory Surgery and Services Databases from 6 states were utilized. There were 3 Current Procedural Terminology codes (23455, 23462, 29806) used to identify open Bankart repair, the Latarjet procedure, and arthroscopic Bankart repair, respectively. Patient demographic and surgical variables were evaluated on a univariate basis, and all significant factors were then included in the multiple linear regression to determine which factors had the largest effect on cost. Total charges billed for the encounter were used as a proxy for cost of surgery. Results: For open Bankart repair, arthroscopic Bankart repair, and the Latarjet procedure, longer operative times increased costs, and high-volume surgical facilities had decreased charges. For the arthroscopic Bankart group, additional factors that increased charges included postoperative hospital admission (US$11,516; P < .001), patient residence in a ZIP code with a below-median income (US$2909; P < .001), presence of a comorbidity (US$1982; P < .001), male sex (US$1545; P = .003), Hispanic race (US$2493; P = .005), and use of regional anesthesia (US$1898; P = .025). Additional cost drivers for the Latarjet procedure included postoperative hospital admission (US$7028; P = .022) and older age (US$187/y; P = .039). Conclusion: Postoperative admission to the hospital was the largest cost driver for arthroscopic Bankart repair and the Latarjet procedure. Low-volume facilities were the largest cost driver for open Bankart repair. High-volume surgery centers had lower costs when compared with low-volume surgery centers. Regional anesthesia increased costs in the arthroscopic Bankart group. These findings may help to show where cost savings can be achieved, particularly considering increasing trends toward bundled health care payments. SN - 2325-9671 UR - https://www.unboundmedicine.com/medline/citation/32613022/Cost_Drivers_Associated_With_Anterior_Shoulder_Stabilization_Surgery L2 - http://journals.sagepub.com/doi/full/10.1177/2325967120926465?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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