Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
J Shoulder Elbow Surg. 2018 Feb;27(2):237-241. doi: 10.1016/j.jse.2017.07.011. Epub 2017 Sep 28.
Very limited information exists about factors affecting direct clinical costs of rotator cuff repair surgery. The purpose of this study was to determine the direct cost of outpatient arthroscopic rotator cuff repair surgery using a unique value-driven outcomes tool and to identify patient- and treatment-related variables affecting cost.
Cost data were derived for arthroscopic rotator cuff repairs performed by 3 surgeons from March 2014 to June 2015 using the value-driven outcomes tool. Costs included overall total direct cost, which included facility utilization costs, medication costs, supply costs, and other ancillary costs. Univariate and multivariate regressions were performed to determine the effect of various patient-related and surgical-related factors on costs.
There were 170 arthroscopic rotator cuff repairs performed during the study period. Multivariate analysis showed significant correlations between higher total direct cost and the presence of a subscapularis repair being performed (P = .015) and total number of anchors used (P < .0001). Higher body mass index, severe systemic illness, 1 of the 3 surgeons, biceps tenodesis using an anchor, and total sum of anchors were correlated with higher facility utilization costs (P < .04). Severe systemic illness, addition of a subscapularis repair, 1 of the 3 surgeons, and additional subacromial decompression were correlated with higher pharmacy costs (P < .006). The addition of a subscapularis repair, total sum of anchors, and severe muscle changes to the supraspinatus were correlated with higher supply costs (P < .015).
From a direct cost perspective, implementation of strategies to reduce overall costs should focus on reducing overall anchor quantity or price.
关于影响肩袖修复手术直接临床成本的因素，相关信息非常有限。本研究旨在使用独特的价值驱动型结果工具确定门诊关节镜肩袖修复手术的直接成本，并确定影响成本的患者和治疗相关变量。
使用价值驱动型结果工具，对 3 位外科医生于 2014 年 3 月至 2015 年 6 月期间进行的关节镜肩袖修复手术的成本数据进行了推导。成本包括总直接总成本，其中包括设施利用成本、药物成本、供应成本和其他辅助成本。进行了单变量和多变量回归分析，以确定各种患者相关和手术相关因素对成本的影响。
研究期间共进行了 170 例关节镜肩袖修复术。多变量分析显示，总直接总成本与肩胛下肌修复术的存在（P = .015）和使用的锚钉总数（P < .0001）之间存在显著相关性。较高的体重指数、严重的全身性疾病、3 位外科医生中的 1 位、使用锚钉的肱二头肌固定术和总锚钉数与较高的设施利用成本相关（P < .04）。严重的全身性疾病、肩胛下肌修复术的增加、3 位外科医生中的 1 位和额外的肩峰下减压术与较高的药房成本相关（P < .006）。肩胛下肌修复术的增加、总锚钉数和冈上肌严重肌肉变化与更高的供应成本相关（P < .015）。
从直接成本的角度来看，实施降低总成本的策略应侧重于减少总体锚钉数量或价格。
