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A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability

BACKGROUND: 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...

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Autores principales: Chalmers, Peter N., Uffman, William, Christensen, Garrett, Greis, Patrick, Aoki, Stephen, Nelson, Richard, Yoo, Minkyoung, Tashjian, Robert Z.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256881/
https://www.ncbi.nlm.nih.gov/pubmed/32490417
http://dx.doi.org/10.1016/j.jseint.2020.01.006
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author Chalmers, Peter N.
Uffman, William
Christensen, Garrett
Greis, Patrick
Aoki, Stephen
Nelson, Richard
Yoo, Minkyoung
Tashjian, Robert Z.
author_facet Chalmers, Peter N.
Uffman, William
Christensen, Garrett
Greis, Patrick
Aoki, Stephen
Nelson, Richard
Yoo, Minkyoung
Tashjian, Robert Z.
author_sort Chalmers, Peter N.
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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 (P < .0001), posterior vs. anterior instability (P = .001), recurrent instability vs. first-time dislocation (P = .025), remplissage (P = .006), rotator interval closure (P = .021), bicep tenodesis (P = .020), rotator cuff repair (P < .0001), an inpatient stay (P = .003), and repair of humeral avulsion of the glenohumeral ligaments (P = .012). CONCLUSION: 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.
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spelling pubmed-72568812020-06-01 A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability Chalmers, Peter N. Uffman, William Christensen, Garrett Greis, Patrick Aoki, Stephen Nelson, Richard Yoo, Minkyoung Tashjian, Robert Z. JSES Int Article BACKGROUND: 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. METHODS: 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. RESULTS: 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 (P < .0001), posterior vs. anterior instability (P = .001), recurrent instability vs. first-time dislocation (P = .025), remplissage (P = .006), rotator interval closure (P = .021), bicep tenodesis (P = .020), rotator cuff repair (P < .0001), an inpatient stay (P = .003), and repair of humeral avulsion of the glenohumeral ligaments (P = .012). CONCLUSION: 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. Elsevier 2020-03-16 /pmc/articles/PMC7256881/ /pubmed/32490417 http://dx.doi.org/10.1016/j.jseint.2020.01.006 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Chalmers, Peter N.
Uffman, William
Christensen, Garrett
Greis, Patrick
Aoki, Stephen
Nelson, Richard
Yoo, Minkyoung
Tashjian, Robert Z.
A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability
title A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability
title_full A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability
title_fullStr A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability
title_full_unstemmed A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability
title_short A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability
title_sort single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256881/
https://www.ncbi.nlm.nih.gov/pubmed/32490417
http://dx.doi.org/10.1016/j.jseint.2020.01.006
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