Surgeon-Directed Cost Variation in Isolated Rotator Cuff Repair

Area of Science:

• Orthopedic Surgery
• Health Economics
• Value-Based Healthcare

Background:

• Healthcare decision-making increasingly emphasizes value, defined as outcome divided by cost.
• Analyzing cost data reveals regional and physician variations in healthcare spending.
• Third-party spend items, chosen by surgeons, significantly impact procedure costs and overall care value.

Purpose of the Study:

• To conduct a cost analysis of isolated rotator cuff repair surgeries within a seven-hospital regional system.
• To identify and quantify the variation in procedure costs among different operating surgeons.

Main Methods:

• Retrospective economic and decision analysis (Level of evidence, 4).
• Utilized Current Procedural Terminology (CPT) codes to identify isolated rotator cuff repairs.
• Collected cost data for surgeon-selected third-party items, categorized into suture anchors, passing devices, repair sutures, and disposable tools.

Main Results:

• Sixty-two isolated rotator cuff repairs by 17 surgeons over 13 months showed total third-party spend ranging from $293 to $3752 (mean $1826).
• Suture anchors exhibited the highest cost variation ($75-$1775, mean $403).
• Significant cost differences were observed across all item categories, including passing needles ($140-$995, mean $468) and repair sutures ($18-$298, mean $61).

Conclusions:

• Substantial cost variation exists in isolated rotator cuff repairs, influenced by surgeon choice.
• Suture anchors are the most costly and variable component of surgeon-directed spending.
• Engaging surgeons in cost discussions presents an opportunity for significant cost savings, potentially enhancing patient care value without compromising outcomes.