Variations in Rotator Cuff Repairs: An Analysis of Concomitant Procedures Over Time and By Surgeon Volume
Poster #: 112
Session/Time: A
Author:
Kush Shah, BS
Mentor:
Kevin Bonner, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Surgeon training, experience, patient characteristics, tear patterns, and coexisting pathologies can lead to variations in surgical technique and concomitant procedure choice during rotator cuff repair (RCR). These variations can result in differences in outcomes and costs for individual patients. The purpose of this study was to assess trends in concomitant procedures during RCR across time and by surgeon case volume.
METHODS:
This was a retrospective cohort study of adult patients who underwent rotator cuff repair at a Sentara hospital in Hampton Roads between January 1, 2015, and March 31, 2021. Patients were identified using billing CPT codes and included if they underwent arthroscopic RCR (29827), open RCR (chronic) (23412) or open RCR (acute) (23410) during the timeframe. Variables were extracted from the EPIC electronic medical record and included surgeon case volume, total cost of hospital stay, time in operating room, patient sex, race, and age, year of surgery, concomitant procedures, ICD-10 diagnoses codes, and number of CPT codes billed per RCR. Patients were stratified based on mean annual surgeon volume as follows: 1-2, 3-5, 6-25, 26-50, and 50+ cases per year. Statistical analyses were performed using R Statistical Software (R Core Team 2021) to assess the effect of year and surgeon volume on dependent variables. ANOVAs were performed for continuous variables and Chi-square/Fisher's Exact Tests for categorical variables.
RESULTS:
In total, 4,313 RCRs across 98 surgeons were included in the final analysis. Overall, 96% (n=4010) of cases included at least one concomitant procedure, and the number of CPT codes per procedure averaged 2.08 ± 0.91. During the timeframe, there was a significant increase in the number of concomitant arthroscopic subacromial decompression (P=.02), debridement (P<.001), and biceps tenodesis/tenotomy (P<.001) procedures. The average number of CPT codes per RCR also significantly increased from 1.8 ± 0.84 in 2015 to 2.3 ± 0.89 in 2021 (P<.001). Regarding case volumes, surgeons averaging more than 50 RCRs per year performed a larger ratio of arthroscopic biceps tenodesis/tenotomy (55.3%), debridement (42.0%) and subacromial decompression (93.7%) procedures. Surgeons averaging 25-50 cases per year performed the greatest ratio of arthroscopic distal clavicle excisions (46.4%).
CONCLUSION:
The results of the present study suggest that surgeon case volume/experience plays a role in identifying pathologies common to rotator cuff tears and concomitant procedure choice.
Surgeon training, experience, patient characteristics, tear patterns, and coexisting pathologies can lead to variations in surgical technique and concomitant procedure choice during rotator cuff repair (RCR). These variations can result in differences in outcomes and costs for individual patients. The purpose of this study was to assess trends in concomitant procedures during RCR across time and by surgeon case volume.
METHODS:
This was a retrospective cohort study of adult patients who underwent rotator cuff repair at a Sentara hospital in Hampton Roads between January 1, 2015, and March 31, 2021. Patients were identified using billing CPT codes and included if they underwent arthroscopic RCR (29827), open RCR (chronic) (23412) or open RCR (acute) (23410) during the timeframe. Variables were extracted from the EPIC electronic medical record and included surgeon case volume, total cost of hospital stay, time in operating room, patient sex, race, and age, year of surgery, concomitant procedures, ICD-10 diagnoses codes, and number of CPT codes billed per RCR. Patients were stratified based on mean annual surgeon volume as follows: 1-2, 3-5, 6-25, 26-50, and 50+ cases per year. Statistical analyses were performed using R Statistical Software (R Core Team 2021) to assess the effect of year and surgeon volume on dependent variables. ANOVAs were performed for continuous variables and Chi-square/Fisher's Exact Tests for categorical variables.
RESULTS:
In total, 4,313 RCRs across 98 surgeons were included in the final analysis. Overall, 96% (n=4010) of cases included at least one concomitant procedure, and the number of CPT codes per procedure averaged 2.08 ± 0.91. During the timeframe, there was a significant increase in the number of concomitant arthroscopic subacromial decompression (P=.02), debridement (P<.001), and biceps tenodesis/tenotomy (P<.001) procedures. The average number of CPT codes per RCR also significantly increased from 1.8 ± 0.84 in 2015 to 2.3 ± 0.89 in 2021 (P<.001). Regarding case volumes, surgeons averaging more than 50 RCRs per year performed a larger ratio of arthroscopic biceps tenodesis/tenotomy (55.3%), debridement (42.0%) and subacromial decompression (93.7%) procedures. Surgeons averaging 25-50 cases per year performed the greatest ratio of arthroscopic distal clavicle excisions (46.4%).
CONCLUSION:
The results of the present study suggest that surgeon case volume/experience plays a role in identifying pathologies common to rotator cuff tears and concomitant procedure choice.