Evaluating Cost Disparities and Utilization of Shoulder Arthroscopy: A National Analysis of Racial, Ethnic, and Socioeconomic Determinants.

Abstract

Background: Shoulder arthroscopy is increasingly common for treating various shoulder pathologies, but racial, ethnic, and geographic disparities in its use persist, especially as more procedures move to ambulatory surgery centers. Identifying and addressing these disparities is crucial for ensuring equitable orthopaedic care in the United States.

Hypothesis/purpose: It was hypothesized that racial and ethnic disparities exist in shoulder arthroscopy utilization. The purpose of this study was to assess these disparities and their contributing factors in greater detail.

Study design: Descriptive epidemiology study.

Methods: This study used the 2019 National Ambulatory Surgery Sample (NASS) to evaluate utilization patterns for shoulder arthroscopy in the United States. Age-standardized utilization rates were calculated for racial and ethnic subgroups. Multivariate Poisson regression models were used to assess disparities, incorporating patient demographics, socioeconomic factors, and facility characteristics as covariates. Differences in total charges were also analyzed.

Results: An estimated 340,892 shoulder arthroscopy surgeries were performed nationwide in 2019, with a mean charge of $32,910. The patient cohort was 57.34% male and 80.26% White, and 78.4% of the patients were older than 45 years. The most common indications for shoulder arthroscopy in this patient cohort were rotator cuff injury (59.96%), labral tear (8.17%), and impingement syndrome (8.32%). There were notable disparities in shoulder arthroscopy by race and ethnicity. White patients had higher utilization rates for shoulder arthroscopy (138.7/100,000) compared with Black (73.0), Hispanic (50.7), and Asian/Pacific Islander (36.5) patients, with an adjusted rate ratio (aRR) of 1.29. White patients were charged less on average for shoulder arthroscopy procedures ($32,183) compared with non-White patients ($35,474). Disparities persisted across all indications, with White patients showing higher utilization rates for rotator cuff repairs (aRR = 1.17) and shoulder instability (aRR = 1.22) and consistently lower charges ($34,438 vs $37,175 for rotator cuff repair; $32,568 vs $35,732 for instability). Geographic disparities were observed, with mean charges of $28,657 in the Northeast and Midwest and $36,309 in the South and West. Black (15.38%), Hispanic (13.15%), and Asian/Pacific Islander (11.24%) patients had higher Medicaid rates than White patients (7.3%). Black (42.9%) and Hispanic (28.97%) patients were more likely to live in low-income areas compared with White patients (20.52%).

Conclusion: There are well-defined disparities in the use of orthopaedic surgery among different patient populations in the United States. Differences in utilization rates, costs incurred, and patient-reported outcomes of shoulder arthroscopy mirror those of hip and knee arthroscopy. These trends continue to worsen and may reflect the changing landscape of healthcare delivery. These trends must be closely analyzed to help define their effect on the disparities experienced by disadvantaged populations in the United States.