Cost Analysis of Failed Shoulder Stabilization

Abstract

ABSTRACTBackgroundShoulder instability is a common problem, especially in the young, active population. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. The challenge for surgeons is identifying the best surgery for each patient. To our knowledge, no studies have been published examining the cost of failed shoulder stabilization.HypothesisThe high cost of index and revision stabilization procedures in a cohort of patients with recurrent shoulder instability can be reduced through judicious preoperative planning and the use of more aggressive surgical techniques during the index operation.MethodsWe retrospectively reviewed the medical records and billing information of 18 consecutive patients treated at our institution for failed shoulder instability repairs during a 36-month period. Using the billing records for each case, a cost analysis was conducted from a societal perspective.ResultsThe actual costs of index stabilization and revision stabilization procedures for our cohort of 18 patients amounted to $1,447,690. The costs of revision surgeries conducted for this cohort by a single surgeon at our institution amounted to $673,248. The hypothetical costs of primary arthroscopic stabilization and open stabilization for a cohort of 18 patients leading to permanent repair was $395,415 and $585,639 respectively. The incremental difference between actual costs and hypothetical costs of primary osteoarticular (OA) allograft stabilization for patients with bony defects is $278,394. For patients with significant bone defects, an open repair with failure rate of 44.9%, or an arthroscopic repair with failure rate of 62.8%, is cost neutral to a primary open repair with OA allograft. In addition, an open repair with failure rate of 13.0%, or an arthroscopic repair with failure rate of 41.3%, is cost neutral to a primary definitive repair.ConclusionFailed shoulder stabilization bears high costs to society, even without considering the psychological costs to patients. We must identify and refine diagnostic and prognostic factors to better determine the appropriate treatment modality for patients with primary shoulder instability.Godin JA, Skendzel JG, Sekiya JK. Cost Analysis of Failed Shoulder Stabilization. The Duke Orthop J 2015;5(1):14-19.