Cost Analysis of Dermal Allograft Patch Utilization in Rotator Cuff Repair

Abstract

PurposeTo perform an analysis of intra-operative costs associated with arthroscopic rotator cuff repair acellular dermal allograft patch augmentation and interposition. MethodsThis was a matched cohort retrospective cost identification analysis. We identified patients who underwent arthroscopic rotator cuff repair with acellular dermal allograft patch augmentation or interposition between 2014 to 2023 at a single academic center. These were matched based on age and tear size to a cohort of patients who underwent arthroscopic rotator cuff repair without a patch. Patients without preoperative MRI data were excluded. Via chart review, we collected demographics, medical comorbidities, tear characteristics, and intra-operative repair characteristics. Patch and control patients were compared with paired t tests. Differences in costs between patch and control patients were assessed using multivariable regression controlling for observable covariates. ResultsOne hundred and thirty-two (132) total patients were included: 66 patch patients and 66 control patients. The patch group demonstrated more tear retraction and utilized single row medial repair more frequently. Multivariable analysis revealed that there was a $4,930 total direct cost increase with the utilization of a patch (p<0.001) after controlling for age, BMI, ASA, CCI, gender, surgeon, tear width, number of anchors, occupation, biceps treatment, prior surgery, and repair construct. The multivariable analysis also revealed that a higher ASA was associated with a $1,440 increase in cost (p=0.012). Biceps tenotomy was associated with a $3,303 decrease in cost compared to tenodesis (p=0.001). Additionally, single row medial repair demonstrated a $1,745 decrease in total direct cost when compared to a double row repair construct (p=0.019). ConclusionThe addition of a patch increases the total direct cost by $4,930 when compared to arthroscopic RCR without a patch. Increased ASA, biceps tenodesis, and use of a double row repair construct were also associated with increased cost.