Cost Drivers Associated With Anterior Shoulder Stabilization Surgery.

Area of Science:

• Orthopedic Surgery
• Health Economics
• Medical Cost Analysis

Background:

• Arthroscopic Bankart repair, open Bankart repair, and the Latarjet procedure are common surgical treatments for anterior shoulder instability.
• Limited data exists on patient- and surgeon-specific factors influencing the costs of these procedures.
• Identifying cost-reduction opportunities is essential, especially with evolving healthcare payment models.

Purpose of the Study:

• To identify patient and surgeon-specific factors associated with increased total charges for shoulder instability procedures.
• To pinpoint areas where cost reduction may be achieved in the surgical treatment of anterior shoulder instability.

Main Methods:

• Economic and decision analysis utilizing data from the 2014 State Ambulatory Surgery and Services Databases from six states.
• Identification of open Bankart repair (CPT 23455), Latarjet procedure (CPT 23462), and arthroscopic Bankart repair (CPT 29806).
• Univariate and multiple linear regression analyses of patient demographics and surgical variables to determine cost drivers.

Main Results:

• Longer operative times and low-volume surgical facilities increased costs for all procedures studied.
• For arthroscopic Bankart repair, key cost drivers included postoperative hospital admission, lower patient income, comorbidities, male sex, Hispanic race, and regional anesthesia.
• Postoperative hospital admission and older patient age were significant cost drivers for the Latarjet procedure.

Conclusions:

• Postoperative hospital admission significantly increased costs for arthroscopic Bankart repair and the Latarjet procedure.
• Low-volume facilities were the primary cost driver for open Bankart repair, while high-volume centers demonstrated lower costs.
• Findings highlight potential cost savings, particularly concerning postoperative care and facility volume, relevant to bundled payment initiatives.