Li Lambert T, Chuck Carlin, Bokshan Steven L, DeFroda Steven F, Owens Brett D
Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI.
Arthrosc Sports Med Rehabil. 2021 Jan 30;3(2):e315-e322. doi: 10.1016/j.asmr.2020.09.020. eCollection 2021 Apr.
To identify cost drivers of open biceps tenodesis, arthroscopic biceps tenodesis, and arthroscopic SLAP repair in the setting of isolated SLAP tears and to perform a direct cost comparison between the procedures.
The 2014 State Ambulatory Surgery and Services Databases from 6 US states were used. Cases with Current Procedural Terminology codes 23430 (tenodesis of long tendon of biceps), 29807 (shoulder arthroscopy, repair of SLAP lesion), and 29828 (shoulder arthroscopy, biceps tenodesis) were selected, excluding patients who were >50 years old or had a concomitant rotator cuff repair. Generalized linear models were used to model costs based on surgical and patient variables.
The mean patient age was 41.8 years for open biceps tenodesis, 31.6 for arthroscopic SLAP repair, and 41.3 for arthroscopic biceps tenodesis ( < .001). Open biceps tenodesis had cost reductions of $5,664 over arthroscopic biceps tenodesis ( = .001) and $2,320 over arthroscopic SLAP repair ( = .043). Male sex was associated with $3,798 more in costs ( < .001), presence of ≥1 comorbidities added $1,829 ( = .002), and each minute in the operating room added $37 ( < .001). Operative time for open biceps tenodesis averaged 114 minutes, and both arthroscopic procedures averaged 94 minutes ( < .001). Low-volume facilities were associated with $5,536 higher costs for arthroscopic biceps tenodesis ( = .001).
In patients aged ≤50 years with isolated SLAP tears, open biceps tenodesis provides cost savings over arthroscopic methods of treatment. There was no significant cost difference between arthroscopic SLAP repairs and arthroscopic biceps tenodesis. Given the increased emphasis on cost containment, surgeons should be aware of the procedural costs associated with the treatment of SLAP tears.
III, retrospective cohort study.
确定在孤立性肩袖上表面（SLAP）撕裂情况下开放性肱二头肌肌腱固定术、关节镜下肱二头肌肌腱固定术以及关节镜下SLAP修复术的成本驱动因素，并对这些手术进行直接成本比较。
使用来自美国6个州的2014年国家门诊手术和服务数据库。选择具有当前手术操作术语代码23430（肱二头肌长头肌腱固定术）、29807（肩关节镜检查，SLAP损伤修复）和29828（肩关节镜检查，肱二头肌肌腱固定术）的病例，排除年龄大于50岁或同时进行肩袖修复的患者。使用广义线性模型根据手术和患者变量对成本进行建模。
开放性肱二头肌肌腱固定术患者的平均年龄为41.8岁，关节镜下SLAP修复术患者为31.6岁，关节镜下肱二头肌肌腱固定术患者为41.3岁（P<0.001）。开放性肱二头肌肌腱固定术的成本比关节镜下肱二头肌肌腱固定术降低了5664美元（P = 0.001），比关节镜下SLAP修复术降低了2320美元（P = 0.043）。男性的成本比女性高3798美元（P<0.001），存在≥1种合并症会增加1829美元（P = 0.002），手术室中的每一分钟会增加37美元（P<0.001）。开放性肱二头肌肌腱固定术的平均手术时间为114分钟，两种关节镜手术的平均手术时间均为94分钟（P<0.001）。低容量医疗机构进行关节镜下肱二头肌肌腱固定术的成本比高容量医疗机构高5536美元（P = 0.001）。
在年龄≤50岁的孤立性SLAP撕裂患者中，开放性肱二头肌肌腱固定术比关节镜治疗方法节省成本。关节镜下SLAP修复术和关节镜下肱二头肌肌腱固定术之间没有显著的成本差异。鉴于对成本控制的重视程度增加，外科医生应了解与SLAP撕裂治疗相关的手术成本。
III级，回顾性队列研究。
