Healthcare economic burden of unresolved slipping rib syndrome

Objective

To evaluate the healthcare costs associated with unresolved slipping rib syndrome (SRS).

Methods

Data pertaining to patients who underwent operative repair for SRS at our academic institution were analyzed retrospectively. Duration of symptoms, previous management efforts, number of healthcare provider consultations, imaging studies, adjunctive surgical and pain management procedures performed to treat the symptoms, and prior unsuccessful SRS operations were catalogued. US Medicare billing standards were used to average costs for provider visits and overall cost of surgical and interventional pain management procedures. Analgesic medication costs were determined using generic pricing.

Results

Between February 2019 and January 2024, a total of 435 consecutive patients spent a median of 36 months searching for a diagnosis and symptom relief prior to evaluation at our institution. The median number of physicians consulted was 6 (range, 0-75). The total cost of physician visits was $2,990,434 USD. The median number of imaging studies was 5 (range, 0-55), at a total cost of $965,949. Cholecystectomy was performed in 47 patients (11%), at a cost of $716,750. Previous SRS surgery had been attempted 150 times at various institutions and accounted for $4,500,000 (estimated $30,000 per operation in billing). Intercostal nerve block, ablation, and spinal cord stimulator placement had been performed in 30%, 15%, and 5% of the patients, respectively, at a total cost of $963,821. The median number of analgesic medications used per patient was 1 (mean, 1.3; range, 0-5); the total medication cost was $1,111,860. The total preoperative healthcare cost in our series was $12,445,173, for an average of $28,610 per patient.

Conclusions

SRS remains poorly understood. Symptoms can be severe and debilitating, and patients frequently consume significant healthcare resources. With recognition and definitive surgical management, SRS may be addressed successfully. Prompt treatment has the potential for significant healthcare savings.