Abstract
Purpose of the study:
Improved technology, increasing experience and techniques warrant an analysis of cost effective ways of medical management in general and shoulder decompression specifically. The question raised was whether a less invasive technique is necessarily the most cost effective way or merely the surgeons' preferred technique.
This is a retrospective study of patients at Tertiary Academic Institution who underwent an open or arthroscopic shoulder decompression in the past 3 years.
The aim of the study is to do a cost analysis of shoulder surgery as private health care (medical aid) is demanding more cost effective procedures and we have limited funds in the Government setting.
Methods:
We focused on the following: the surgeon; the procedure; operating time; inpatient time; intraoperative block; physiotherapy costs, time off work and the cost of instrumentation used. Patients had to comply with specific inclusion and exclusion criteria.
Inclusion: All patients that had shoulder decompression surgery in the past three years by a qualified orthopaedic surgeon; Exclusion: sepsis, tumours, rotator cuff tears, conversion of an arthroscopic procedure to an open procedure intraoperatively, inadequate notes, multiple surgical procedure under the same anaesthetic (e.g. scope with a trapezium excision).
Results:
We evaluated 260 patients. Only 147 complied with the inclusion and exclusion criteria, of which 54 were open decompressions and 73 were arthroscopic decompressions. Arthroscopic surgery was significantly more expensive than open surgery (p<0.0001).
Conclusion:
With a 95% confidence level, we concluded that the total cost of an arthroscopic decompression can be between 257.5% and 285.0% higher than that of an open decompression.
The outcome of this study has proven that we need to take the cost of every procedure into consideration as our patients can benefit more by the redistribution of funds for other possible procedures.
Level of evidence:
Level III
