Cost drivers and delays in recovery following rotator cuff repair: insights from a national claims database.

Abstract

Aims: This study aimed to establish a real-world benchmark of recovery following rotator cuff repair (RCR) using healthcare claims data. Secondary objectives included determining the effect of comorbidities and complications such as joint contracture, additional procedures, and rehospitalizations on the recovery timeline and costs.

Materials and methods: Healthcare claims data from the IBM MarketScan Commercial Claims and Encounters Database (2015-2018) were reviewed to determine costs and recovery time after RCR. Costs and recovery duration (index surgery to last therapy claim) were calculated. Subgroup analyses assessed the effects of comorbidities (diabetes, obesity, peripheral vascular disease, cardiovascular disease) and postoperative events (revision, motion restoring surgery (MRS), complication-related surgery, and nonoperative hospitalization) on outcomes. Perioperative complications including joint fibrosis/contracture, infection, and pulmonary embolus were also reported. Descriptive statistics including medians with interquartile ranges (IQR) were reported.

Results: In the 14,947 patients included in analysis, median index surgery cost was $11,454 (IQR = $8,169-$17,204). Median recovery was 153 days (IQR = 79-683). Development of postoperative shoulder contracture or adhesive capsulitis added a median of 162 recovery days and nearly doubled costs. Patients requiring surgery for a complication had 3.5-fold longer recoveries and 5-fold higher costs than those without complications. MRS increased recovery time and costs nearly 3-fold, and patients undergoing MRS were 7 times more likely to require arthroplasty. Comorbidities extended recovery by 30-90 days, modestly increased costs, and were associated with a 2-3 times higher frequency of pulmonary embolism.

Limitations: Claims data may be affected by coding inconsistencies, lack of clinical detail, and inability to capture medication costs or outcomes beyond the last therapy claim.

Conclusions: This study defined a benchmark for recovery after RCR and found that complications including contracture and motion restoring surgery substantially increased recovery time and costs. These benchmarks can guide earlier identification of patients at risk for delayed recovery and help in evaluating strategies to reduce economic burden and improve outcomes.