Chalmers Peter N, Uffman William, Christensen Garrett, Greis Patrick, Aoki Stephen, Nelson Richard, Yoo Minkyoung, Tashjian Robert Z
Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA.
Department of Epidemiology, University of Utah Medical Center, Salt Lake City, UT, USA.
JSES Int. 2020 Mar 16;4(2):297-301. doi: 10.1016/j.jseint.2020.01.006. eCollection 2020 Jun.
Although surgical shoulder stabilization is a substantial cost nationally within the United States, little information exists to analyze this cost. The purpose of this study was to identify factors associated with variation in direct costs with the arthroscopic treatment of glenohumeral instability.
This was a retrospective study of all patients who underwent arthroscopic treatment of glenohumeral instability between January 12, 2012 and July 11, 2017. Patient and procedure factors were collected. Direct perioperative costs were collected using a validated internal tool. Patient and procedure characteristics significantly associated with costs were identified using multivariate generalized linear models.
The study included 302 patients, of whom 12% were undergoing revision and 32% were contact or collision athletes. Anterior instability was present in 73%, whereas 14% had posterior and 10% had multidirectional instability. Of the patients, 67% were recurrent dislocators and 33% were first-time dislocators or subluxators. Remplissage was performed in 13%; biceps tenodesis, 5%; and rotator cuff repair, 3%. An average of 4.0 ± 1.4 anchors were used. Of costs, 39% were operative facility utilization costs and 41% were implant costs. Factors associated with cost increase included an increased number of anchors ( < .0001), posterior vs. anterior instability ( = .001), recurrent instability vs. first-time dislocation ( = .025), remplissage ( = .006), rotator interval closure ( = .021), bicep tenodesis ( = .020), rotator cuff repair ( < .0001), an inpatient stay ( = .003), and repair of humeral avulsion of the glenohumeral ligaments ( = .012).
Most perioperative costs associated with the arthroscopic treatment of glenohumeral instability are facility utilization and implant costs. Nonmodifiable factors associated with increased cost included posterior direction of instability and recurrent instability. Modifiable factors included additional procedures and inpatient stay.
尽管在美国，肩部手术稳定术在全国范围内成本高昂，但用于分析此成本的信息却很少。本研究的目的是确定与关节镜治疗盂肱关节不稳直接成本变化相关的因素。
这是一项对2012年1月12日至2017年7月11日期间接受关节镜治疗盂肱关节不稳的所有患者的回顾性研究。收集了患者和手术因素。使用经过验证的内部工具收集围手术期直接成本。使用多变量广义线性模型确定与成本显著相关的患者和手术特征。
该研究纳入了302例患者，其中12%接受翻修手术，32%为接触性或碰撞性运动员。73%存在前方不稳，而14%为后方不稳，10%为多方向不稳。患者中，67%为复发性脱位者，33%为首次脱位或半脱位者。13%的患者进行了关节囊紧缩术；5%进行了肱二头肌固定术；3%进行了肩袖修复术。平均使用4.0±1.4枚锚钉。成本方面，39%为手术设施使用成本，41%为植入物成本。与成本增加相关的因素包括锚钉数量增加（P<0.0001）、后方不稳与前方不稳相比（P = 0.001）、复发性不稳与首次脱位相比（P = 0.025）、关节囊紧缩术（P = 0.006）、旋转间隔闭合（P = 0.021）、肱二头肌固定术（P = 0.020）、肩袖修复术（P<0.0001）、住院（P = 0.003）以及盂肱韧带肱骨撕脱修复（P = 0.012）。
与关节镜治疗盂肱关节不稳相关的大多数围手术期成本是设施使用和植入物成本。与成本增加相关的不可改变因素包括不稳的后方方向和复发性不稳。可改变因素包括额外的手术和住院时间。
