Cost Drivers for Single-Tendon Rotator Cuff Repair: Day-of-Surgery Time-Driven Activity-Based Costing Analysis.

Abstract

Background: The purpose of this study was to determine the patient-driven and surgical characteristics that drive day-of-surgery (DOS) costs for repair of isolated supraspinatus tears.

Methods: All patients who underwent primary rotator cuff repair (RCR) for isolated supraspinatus tears within one health care system from 2016 to 2022 were inclusion eligible. Exclusion criteria included concomitant tear of infraspinatus, teres minor, or subscapularis; previous RCR or fractures of affected shoulder; diagnosis of rheumatoid arthritis; and incomplete baseline or 1-year patient-reported outcomes. Patient demographic information, injury characteristics, surgical technique/supplies, operative time stamps, symptomatic retear, and reoperation rates data were extracted from patients' electronic medical records and retrospectively reviewed. Time-driven activity-based costing was derived from direct and indirect DOS cost of care.

Results: A total of 236 patients who underwent primary RCR for isolated supraspinatus tears from 2016 to 2022 were included. The average DOS cost was $2,443 ± $832. The average implant cost was $1,066 ± $654, accounting for 87% of variation in DOS costs. Upon univariate analysis, depression (p = 0.045), full-thickness tears (p < 0.001), double-row repair (p < 0.001), subacromial decompression (p < 0.001), distal clavicle excision (p = 0.003), biceps tenodesis (p < 0.001), number of suture anchors (p < 0.001), and operating surgeon (p < 0.001) were associated with higher DOS costing. Multivariable linear regression analysis using characteristics that demonstrated statistical significance on univariate analysis revealed that depression, full-thickness tears, double-row repairs, subacromial decompression, distal clavicle excision, biceps tenodesis, and number of suture anchors were significant predictors of cost (p < 0.05).

Conclusions: Significant predictors of DOS costing for isolated supraspinatus RCRs include depression, full-thickness tear, double-row repair, subacromial decompression, distal clavicle excision, biceps tenodesis, number of suture anchors, and operating surgeon. Providing surgeons with this information can enable greater cost-transparency and, in conjunction with clinical judgement and patient preference, better equip them to deliver high-quality value-based care.

Level of evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.