Distal Clavicle Excision: An Epidemiologic Study Using the National Ambulatory Surgery Sample Database

Background: This study aimed to examine national trends pertaining to patient demographics and hospital characteristics among distal clavicle excision (DCE) procedures performed in the United States. Methods: The National Ambulatory Surgery Sample (NASS) database was queried for data. Encounters with Current Procedural Terminology (CPT) code 29824 were selected. Metrics derived from these encounters included patient demographic information such as age, geographic location, median household income per zip code, and primary expected insurance payer. Hospital characteristics derived included total charges for DCE procedures, location of the hospital, disposition of the patient, hospital census region, control/ownership of the hospital, and location/teaching status of the hospital. The proportion of DCE performed concomitantly with rotator cuff repair (RCR) was also analyzed. P-values were obtained from continuous variables using a t-test with a linear regression model. P-values were obtained from event variables using chi-square analysis. Results: The incidence of arthroscopic DCE in the US decreased from 99,070 in 2016 to 93,678 (5.5%) in 2018. Of note, the proportion of DCE performed concomitantly with RCR significantly increased from 50.4% in 2016 to 52.8% in 2018 (P < 0.0001). Median patient age increased from 2016 to 2018 (56.4 to 57.2; P < 0.0001). The income quartile that saw the highest number of encounters was between $43,000 and $53,999 (P < 0.0001). Hospital trends display an increasing cost from $16,944 to $18,855 over the study period (P = 0.0016). Private insurance, including health maintenance organizations (HMOs), were the largest payers for this procedure; however, a decreasing trend in DCE covered by private insurance was noticed (50.2% to 47.3%; P < 0.0001). Medicare was the second-largest payer ranging from 27.9% in 2016 to 29.9% in 2018. The urban teaching model of hospitals continues to see the highest number of encounters for this procedure. Conclusions: In both 2016 and 2018, private insurance was the most common payer, most DCEs were performed in urban teaching hospitals, and most patients undergoing the procedure had a median household income between $43,000 and $59,000. Between 2016 and 2018, there was a significant increase in costs associated with DCE, as well as an increase in the median age of patients undergoing the procedure. The proportion of DCE performed concurrently with RCR also significantly increased during the study period.