National Trends in Rotator Cuff Repair

Considerable literature exists regarding the surgical management of rotator cuff tears. Arthroscopic and open rotator cuff repairs have had comparable clinical results in the literature, with distinct advantages and disadvantages to both procedures1,2. Arthroscopy allows for preservation of the deltoid muscle3, improved ability to treat intra-articular lesions3, improved ability to mobilize and release the rotator cuff3, and less immediate postoperative pain4. Open and mini-open repair techniques allow for easier transosseous fixation to better replicate the footprint of the supraspinatus tendon5 and theoretically may provide a better potential for healing5, although transosseous equivalent constructs with use of suture anchors have been described that also show improved pressurized contact area6,7. Open repair and mini-open repair also allow for the placement of a modified Mason-Allen stitch, which, in comparison with the simple stitch, is a stronger method to grasp the tendon8,9. Several studies have examined geographic variation in the number of rotator cuff surgical procedures performed as well as variations in what surgeons deemed to be indications for rotator cuff surgery. For example, Vitale et al. found a large geographic variation in the number of rotator cuff surgical procedures that were performed in Medicare beneficiaries in 199210. This variation may have reflected a lack of clear operative indications and/or an understanding of the risks and benefits of surgery at the time of the study. With respect to surgical indications, Green et al. reported that surgeon preference was the primary deciding factor for performing inpatient rotator cuff surgery11. Dunn et al. also found significant variation in indications for rotator cuff surgery in a survey of selected members of the American Academy of Orthopaedic Surgeons as of the year 200212. Surgeons who had a higher procedure volume favored rotator cuff surgery more than those who had a lower volume12. Mini-open repair was the most frequently used method of repair (46.2%) followed by open (36.6%) and arthroscopic (14.5%)12. Despite many publications addressing rotator cuff repair techniques, indications for rotator cuff surgery, and outcomes in selected groups of patients, little information has been reported recently on trends of use at the national level. The purpose of our study was multifold. First, we sought to determine current trends in resource utilization for rotator cuff repairs, including type and setting of surgical treatment as well as type of anesthesia. The impact of age and sex on resource utilization was also examined. Finally, we also studied other variables (e.g., procedure length) that contribute to health-care costs. The hypotheses of our study were that (1) surgeons are now performing more arthroscopic rotator cuff repairs, (2) more of these repairs are being performed in ambulatory surgery settings, (3) patients who undergo surgery in an inpatient setting are more likely to be older and have more comorbidities, (4) surgical time is longer for arthroscopic repairs, and (5) the use of interscalene block for anesthesia is increasing.