Reimbursement, efficiency, and safety in rotator cuff repair: a comparative study of arthroscopic and open approaches

Rotator cuff repair (RCR) is one of the most common orthopedic procedures in the United States. Although arthroscopic and open RCR yield similar long-term outcomes, differences in reimbursement and short-term safety are less understood. This study aimed to evaluate differences between RCR techniques in work relative value units (wRVUs), operative times, Medicare reimbursement amounts, and 30-day complication rates.

For data collection, the National Surgical Quality Improvement Program database was retrospectively analyzed (2006-2023). Patients undergoing arthroscopic or open RCR were identified by Current Procedural Terminology codes and matched 1:1 via propensity score matching according to demographics and comorbidities. Outcomes included operative time, wRVUs, Medicare reimbursement amount, and 30-day postoperative complications.

A total of 18,988 matched patients (9,494 with arthroscopic RCR, 9,494 with open RCR) were included. Arthroscopic RCR cases had significantly longer operative times than open RCR cases (91.82±43.71 minutes vs. 80.93±41.02 minutes, P<0.001) but generated 17.7% higher wRVUs per minute (0.20±0.09 vs. 0.17±0.07, P<0.001) and 36.0% more revenue per case ($485.20±$0.00 vs. $356.77±$7.54, P<0.001). Arthroscopic RCR patients had significantly lower overall 30-day complication rates (1.1% vs. 1.5%, P=0.010), including fewer superficial (0.2% vs. 0.4%, P=0.023) and deep surgical site infections (0.0% vs. 0.2%, P=0.004).

Arthroscopic RCR is associated with lower short-term complication rates than open RCR, despite requiring longer operative times and more resources. This clinical trade-off suggests that the additional operative demands of arthroscopic surgery are justified by the associated improvements in patient safety, highlighting the value of reduced complications as a key advantage of the arthroscopic approach. Level of evidence: III.