Irreparable rotator cuff tears (IRCTs) are common; many patients with IRCT's can manage their symptoms effectively or respond to conservative approaches, such as a simple exercise program (see this link) or a minor surgery, such as the smooth and move procedure (see this link).
More involved surgeries, such as superior capsular reconstruction (SCR), lower trapezius tendon transfers (LTTT) and reverse total shoulder arthroplasty (RSA) pose challenges both clinically and financially. These authors performed an analysis of their costs, complications, and readmission rates of these three surgical treatments for IRCTs: 20 SCRs, 47 LTTTs, and 88 RSAs as performed by experienced surgeons at a major medical center.
The 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. The data are shown below.
In this study, implants represented the highest proportion of the index costs for all 3 procedures with 27.2% in LTTT, 29.1% in RSA, and 31.8% in SCR.
Surgeon charges accounted for 6.2% of the total for SCR, 7.3% for LTTT, and 11.0% for RSA.
Comment: Patients with irreparable rotator cuff tears and others may be bewildered by the completely different options for treating IRCTs: "we could insert a preparation of cadaver skin, we could transfer a tendon, we could replace the joint with a prosthesis that reverses the normal shoulder anatomy or we could not do any of these procedures." How to choose? The cost-effectiveness or value of a surgical procedure is measured as the improvement in comfort and function realized by the patient divided by the cost of the procedure. While these relative cost data from the Mayo Clinic are of interest, it would have been most informative to have seen data on the relative effectiveness of the different procedures in improving the comfort and function of the patients in each group. The combination of cost and effectiveness data would enable determination of the value of these procedures for patients with irreparable cuff tears. See: 30% unsatisfactory results for patients with massive rotator cuff tears having reverse total shoulder arthroplasty
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