Cost Comparison and Complication Profiles of Superior Capsular Reconstruction, Lower Trapezius Transfer, and Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tears.

Abstract

BACKGROUND\nIrreparable rotator cuff tears (IRCT) pose treatment challenges both clinically and financially. As cost effectiveness initiatives are prioritized, value-based healthcare delivery models are becoming increasingly common. The purpose of this study was to perform a comprehensive analysis of the cost, complications, and readmission rates of 3 common surgical treatment options for IRCTs: superior capsular reconstruction (SCR), arthroscopically-assisted lower trapezius tendon transfer (LTT), and reverse shoulder arthroplasty (RSA).\n\n\nMETHODS\nBetween 2018 and 2020, 155 patients who underwent shoulder surgery at a single institution for IRCT with minimal to no arthritis were identified. Procedures performed included 20 SCRs, 47 LTTs, and 88 RSAs. A cost analysis was designed to include a period of 60 days preoperatively, the index surgical hospitalization, and 90 days postoperatively, including costs of any readmission or reoperation.\n\n\nRESULTS\nMean standardized costs were as follows: preoperative evaluation SCR $507, LTT $507, and RSA $730; index surgical hospitalization SCR $19,675, LTT $15,722, and RSA $16,077; and postoperative care SCR $655, LTT $686, and RSA $404. Significant differences were observed in the index surgical costs (P < .001), with SCR incurring an additional average cost of $3,953 and $3,598 when compared to LTT and RSA, respectively. The 90-day complication, reoperation, and readmission rates were 0%, 0%, and 0% in the SCR group; 2.1%, 0%, and 0% in the LTT group; 3.4%, 0%, and 1.1% in the RSA group, respectively. With the numbers available, differences among the 3 surgical procedures with respect to complication (P = .223), reoperation (P =.999), and readmission rates (P =.568) did not reach statistical significance.\n\n\nCONCLUSIONS\nThe mean standardized costs for treatment of three common IRCT procedures inclusive of 60-day workup and 90-day postoperative recovery were $16,915, $17,210 and $20,837 for LTT, RSA (average added cost $295), and SCR (average added cost $3,922), respectively. This information may provide surgeons and institutions with cost-related information that will become increasingly relevant with the expansion of value-based surgical reimbursements.