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Pierami R, Antonioli E, Castro IQ, Fairbanks P, Manente FG, Lenza M. Clinical outcomes and direct cost analysis of rotator cuff repair surgery. EINSTEIN-SAO PAULO 2024; 22:eGS0473. [PMID: 39194070 DOI: 10.31744/einstein_journal/2024gs0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/05/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical and functional outcomes in patients who underwent surgical treatment for rotator cuff tears using open and arthroscopic techniques, and to evaluate the direct costs involved. METHODS Retrospective cohort study with analysis of the data of patients who were referred to two private hospitals in Sao Paulo, Brazil for surgical repair of the rotator cuff from January 2018 to September 2019. Clinical outcomes were assessed using functional scores (SPADI and QuickDASH) and a quality of life questionnaire (EuroQoL). Procedure costs were calculated relative to each hospital's costliest procedure. RESULTS Data from 362 patients were analyzed. The mean patient age was 57 years (SD= 10.46), with a slight male predominance (53.9%). Arthroscopic procedures were more common than open procedures (95.6% versus 4.4%). Significant clinical improvement was reported in 84.8% of the patients. The factors associated with increased surgery costs were arthroscopic technique (increase of 29.2%), age (increase of 0.6% per year), and length of stay (increase of 18.9% per day of hospitalization). CONCLUSION Rotator cuff repair surgery is a highly effective procedure, associated with favorable clinical outcomes and improvement in life quality, and low rates of complications. Arthroscopic surgery tends to be costlier than open surgery.
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Affiliation(s)
- Rafael Pierami
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Hospital Alvorada Moema, São Paulo, SP, Brazil
| | | | | | - Paula Fairbanks
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Felipe Giorgi Manente
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mario Lenza
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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2
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Markus DH, Colasanti CA, Kaplan DJ, Manjunath AK, Alaia MJ, Strauss EJ, Jazrawi LM, Campbell KA. High Rate of Patient Satisfaction with Either Telemedicine or Traditional Office-Based Follow-Up Visit After Arthroscopic Shoulder Surgery. Telemed J E Health 2024; 30:134-140. [PMID: 37318834 DOI: 10.1089/tmj.2022.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background: The purpose of this study was to determine if any differences exist in patient satisfaction with office-based visits versus telemedicine visits following arthroscopic shoulder surgery. Methods: Patients undergoing shoulder arthroscopy were prospectively enrolled for 1 year. Patient demographic and clinical data (including complication events) and second postoperative visit satisfaction data were recorded and analyzed for statistical significance. Results: Ninety-six (n = 96) patients met inclusion criteria. Fifty-four patients (56.3%) participated in a traditional in-person office visit, and 42 participated in a video visit (43.8%). No significant differences were found between office and video appointments in terms of overall care satisfaction (9.46 ± 0.9 vs. 9.55 ± 1.0, p = 0.67). Females were significantly less satisfied with their second postoperative visit compared with males (8.3 ± 2.3 vs. 9.3 ± 1.5, p = 0.035). Significantly more females would also have preferred a traditional in person office visit compared with males (91% vs. 67%, p = 0.009). Video appointment patients spent significantly more time with their surgeon than office visit patients (57.64 mean rank vs. 41.39 mean rank, p = 0.003). Discussion: Video visit patients required significantly less time overall for their visit and spent significantly more time with their surgeon, although did not demonstrate differences in satisfaction.
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Affiliation(s)
- Danielle H Markus
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Christopher A Colasanti
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Daniel J Kaplan
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Amit K Manjunath
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Michael J Alaia
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Eric J Strauss
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
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3
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Eubank BHF, Lackey SW, Slomp M, Werle JR, Kuntze C, Sheps DM. Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada. BMC FAMILY PRACTICE 2021; 22:201. [PMID: 34627163 PMCID: PMC8502088 DOI: 10.1186/s12875-021-01544-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/17/2021] [Indexed: 11/20/2022]
Abstract
Background Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. Methods First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. Conclusions This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01544-3.
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Affiliation(s)
- Breda H F Eubank
- Department of Health & Physical Education, Faculty of Health, Community, & Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta, Canada, T3E 6K6.
| | - Sebastian W Lackey
- Alberta Bone and Joint Health Institute, Suite 316, 400 Crowfoot Crescent NW, Calgary, Alberta, Canada, T3G 5H6
| | - Mel Slomp
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4
| | - Jason R Werle
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4.,Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada, T2N 1N4
| | - Colleen Kuntze
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4.,Access Orthopaedics, 3916 Macleod Trail, Suite 300, Calgary, Alberta, Canada, T2G 2R5
| | - David M Sheps
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4.,Edmonton Bone and Joint Centre, 9499 - 137 Ave NW, Edmonton, Alberta, Canada, T5E 5R8.,Division of Orthopaedics, Department of Surgery, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada, T6G 2R3.,Faculty of Rehabilitation Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada, T6G 2R3
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4
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Marigi EM, Kennon JC, Dholakia R, Visscher SL, Borah BJ, Sanchez-Sotelo J, Sperling JW. Cost analysis and complication rate comparing open, mini-open, and all arthroscopic rotator cuff repair. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:84-89. [PMID: 37588144 PMCID: PMC10426685 DOI: 10.1016/j.xrrt.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Hypothesis/Background Value-based healthcare delivery models are becoming increasingly common and are driving cost effectiveness initiatives. Rotator cuff repair (RCR) is a commonly performed procedure with some variations on the specific surgical technique. The purpose of this study was to perform a comprehensive analysis of the cost, complications, and readmission rates of 3 categories of RCR techniques (open [oRCR], combined arthroscopically assisted and mini-open [CRCR], and all arthroscopic [ARCR]) at a high-volume institution. Methods All RCR procedures performed by 2 fellowship-trained shoulder surgeons at a single institution between 2012 and 2017 were retrospectively identified. These consisted of oRCR, CRCR, and ARCR repair techniques. One surgeon performed oRCR and CRCR, and the second surgeon performed ARCR. 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. Results The cohort consisted of 95 oRCR, 233 CRCR, and 287 ARCR. Median standardized costs were as follows: preoperative evaluation $486.03; index surgical hospitalization oRCR $9,343.10, CRCR $10,057.20, and ARCR $10,330.60; and postoperative care $875.02. Preoperative and postoperative costs did not vary based on the type of RCR performed. However, significant differences were observed among index surgical costs (P = .0008). The highest standardized cost for hospitalization for both the CRCR group and the ARCR group was related to the cost of the operating room and the implants. The 90-day complication, reoperation, and readmission rates were 1.1%, 1.1%, and 2.1% in the open group; 0.8%, 0.8%, and 1.7% in the combination group; 0%, 0%, and 1.7% in the all arthroscopic group, respectively. There were no significant differences among the 3 surgical procedures with respect to complication (P = .26), reoperation (P = .26), and readmission rates (P = .96). Discussion/Conclusions In this investigation, the median standardized costs for RCR inclusive of 60-day workup and 90-day postoperative care were $10,704.15, $11,418.25, and $11,691.65 for oRCR, CRCR (average added cost $714.10), and ARCR (added cost $987.50), respectively. The group complication, reoperation, and readmission rate were 0.5%, 0.5%, and 1.8% with no significant differences between the varying techniques, respectively. This retrospective cost analysis and complication profile may serve as a useful reference as surgeons consider engaging in bundled payment for RCR. As value based initiatives continue to progress, implant cost may serve as an actionable area for cost reduction.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin C. Kennon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruchita Dholakia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sue L. Visscher
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bijan J. Borah
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Mohammed KD, Lloyd RFW, Nagaraj C, Krishnan J. The Relevance of Open Rotator Cuff Repair in 2021. Indian J Orthop 2021; 55:433-442. [PMID: 33927822 PMCID: PMC8046857 DOI: 10.1007/s43465-020-00345-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The last decade has seen a large increase in rotator cuff surgery and arthroscopic surgery. We were asked to define the relevance of open rotator cuff repair in 2021. PURPOSE To define whether there are proven advantages to arthroscopic or open rotator cuff repair surgery. METHOD We reviewed the recent literature regarding recent trends, anaesthetic time, rehabilitation, post-operative pain, complications, economic considerations, the learning curve and outcomes. We outlined the senior authors' technique preferences, rationale and patient reported outcomes. RESULTS There is no clear evidence of proven advantage in arthroscopic rotator cuff repair compared to open rotator cuff repairs, with regard to outcomes or the other aspects reviewed. There were no differences in the outcomes of arthroscopic and open repairs in the senior authors practice with his procedure indications. CONCLUSIONS Open rotator cuff repair surgery remains a valid option and has some appeal in specific indications and in settings where arthroscopic resources are limited. We believe surgeons should learn both techniques and the principles of good patient selection, tissue handling, and fixation techniques are of paramount importance in both arthroscopic and open rotator cuff surgery.
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Affiliation(s)
- Khalid D. Mohammed
- grid.410864.f0000 0001 0040 0934Department of Orthopaedic Surgery, Canterbury District Health Board, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Richard F. W. Lloyd
- grid.410864.f0000 0001 0040 0934Department of Orthopaedic Surgery, Canterbury District Health Board, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | | | - Jegan Krishnan
- grid.414925.f0000 0000 9685 0624Department of Orthopaedic Surgery, Flinders Medical Centre and Repatriation General Hospital, Adelaide, SA Australia ,grid.1014.40000 0004 0367 2697Department of Orthopaedic Surgery, Flinders University, Adelaide, SA Australia
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Morris JH, Malik AT, Hatef S, Neviaser AS, Bishop JY, Cvetanovich GL. Cost of Arthroscopic Rotator Cuff Repairs Is Primarily Driven by Procedure-Level Factors: A Single-Institution Analysis of an Ambulatory Surgery Center. Arthroscopy 2021; 37:1075-1083. [PMID: 33242633 DOI: 10.1016/j.arthro.2020.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify intraoperative drivers of cost associated with arthroscopic rotator cuff repairs (RCRs) through analysis of an institutional database. METHODS This was a single-institution retrospective review of arthroscopic RCRs performed at an ambulatory surgical center between November 2016 and July 2019. Patient-level factors analyzed included age, sex, insurance type (private, Medicare, Medicaid, self-pay, and other government), American Society of Anesthesiologists grade (I, II, III, and missing), and Charlson comorbidity index (0, 1, 2, and ≥3). Procedure-level factors included use of biologics (decellularized dermal allograft or bioinductive healing implant), anesthesia type (regional block, monitored anesthesia care, or general), number of anchors and sutures, additional procedures (biceps tenodesis, distal clavicle resection, subacromial decompression), and operative time. Multivariate linear regression analysis was used to identify factors significantly associated with higher or lower charges. RESULTS A total of 712 arthroscopic RCRs were included. The risk-adjusted operative charges were $19,728 (95% confidence interval $16,543 to $22,913). The above factors predicted nearly 65% of the variability in operative charges. The only patient-level factor significantly associated with lower charges was female sex (- $1,339; P = .002). Procedure-level factors significantly associated with higher charges were use of biologics (+ $17,791; P < .001), concurrent open biceps tenodesis (+ $4,027; P < .001), distal clavicle resection (+ $2,266; P = .039), use of regional block (+ $1,256; P = .004), number of anchors (+ $2,245/anchor; P < .001), and increasing operative time ($26/min). Other factors had no significant association. CONCLUSIONS Procedural factors are the most significant drivers of operative cost in arthroscopic RCRs, such as quantity and type of implants; additional procedures such as biceps tenodesis and distal clavicle resection; and perioperative conditions such as type of anesthesia and total operating room time. Overall, patient-level factors were not shown to correlate well with operative costs, other than lower charges with female sex. LEVEL OF EVIDENCE IV, economic study.
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Affiliation(s)
- Jesse H Morris
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Azeem T Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Sarah Hatef
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Andrew S Neviaser
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A..
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Cost-effectiveness analysis of arthroscopic surgery versus open surgery in rotator cuff repair. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.869051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Grobet C, Audigé L, Eichler K, Meier F, Brunner B, Wieser S, Flury M. Cost-Utility Analysis of Arthroscopic Rotator Cuff Repair: A Prospective Health Economic Study Using Real-World Data. Arthrosc Sports Med Rehabil 2020; 2:e193-e205. [PMID: 32548584 PMCID: PMC7283931 DOI: 10.1016/j.asmr.2020.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose To assess the change in quality of life (QOL) and costs for patients with rotator cuff tears after arthroscopic rotator cuff repair (aRCR) compared with continued nonoperative management, using real-world evidence. Methods Patients indicated for aRCR were included in a prospective study and followed up to 2 years after surgery (postop) for all measurements. QOL (EQ-5D-5L) and shoulder function (Constant Score, Oxford Shoulder Score, subjective shoulder value) were assessed. Sixteen major insurance companies provided all-diagnoses direct medical costs in Swiss francs (CHF; 1 CHF = 1.03 USD). Baseline data at recruitment and costs sustained over 1 year before surgery (preop) served as a proxy for nonoperative management. Total direct medical costs to gain 1 extra quality-adjusted life year (QALY) were calculated as the incremental cost-effectiveness ratio (ICER; mean of 2 years postop compared with 1 year preop) from a societal perspective. Subgroup analyses were separately performed for traumatic (trauma-OP) and degenerative (degen-OP) rotator cuff tear patients. Sensitivity analyses for aRCR patients included more intensive nonoperative treatment with corresponding QOL gain. The relationship between QOL and shoulder function was explored using regression analysis. Results For 153 aRCR patients (mean age 57 years; 63% male), the mean EQ-5D index improved from 0.71 (preop) to 0.94 (1 year postop) and 0.96 (2 years postop). Mean total costs increased from 5,499 CHF (preop) to 17,116 CHF (1 year postop), then decreased to 4,226 CHF (2 years postop). The ICER for all aRCR patients was 24,924 CHF/QALY (95% confidence interval [CI] 16,742 to 33,106) and 17,357 CHF/QALY (95% CI 10,951 to 23,763) and 36,474 CHF/QALY (95% CI 16,301 to 56,648) for the trauma-OP and degen-OP groups, respectively. QOL and shoulder function were significantly associated (P < .001). Conclusions For RC patients treated at a specialized Swiss orthopaedic clinic, aRCR is a cost-effective intervention associated with clinically relevant improvement in QOL up to 2 years after repair compared with prior nonoperative management. Level of Evidence Economic Analyses - Developing an Economic Model, Level II.
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Affiliation(s)
- Cécile Grobet
- Research and Development, Schulthess Klinik, Zurich, Switzerland
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Research and Development, Schulthess Klinik, Zurich, Switzerland
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
- Address correspondence to Laurent Audigé, Ph.D., Schulthess Klinik, Department of Teaching, Research and Development, Lengghalde 2, CH-8008 Zurich, Switzerland.
| | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Flurina Meier
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Beatrice Brunner
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Matthias Flury
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
- Center for Orthopedics & Neurosurgery, In-Motion, Wallisellen, Switzerland
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9
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Kane LT, Thakar O, Jamgochian G, Lazarus MD, Abboud JA, Namdari S, Horneff JG. The role of telehealth as a platform for postoperative visits following rotator cuff repair: a prospective, randomized controlled trial. J Shoulder Elbow Surg 2020; 29:775-783. [PMID: 32197766 DOI: 10.1016/j.jse.2019.12.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The application of telehealth for surgical follow-up has gained recent exposure in orthopedic care. Although the results following joint arthroplasty are encouraging, the role of telemedicine for postoperative care following arthroscopic rotator cuff repair still needs to be defined. The goal of this study was to evaluate the safety, efficacy, and socioeconomic benefits of telehealth as a platform for postoperative follow-up. METHODS This was a prospective, randomized controlled trial that enrolled 66 patients who underwent follow-up in the office vs. via telemedicine for postoperative visits at 2, 6, and 12 weeks after surgery. Post-visit surveys were administered to patients and physicians via e-mail, and the Student t test and Fisher exact test were used to compare responses. RESULTS In total, 58 patients (88%) completed the study (28 telehealth vs. 30 control). Patients in each group demonstrated similar pain scores at each follow-up visit (P = .638, P = .124, and P = .951) and similar overall satisfaction scores (P = .304). Patients in the telehealth group expressed a stronger preference for telehealth than their control counterparts (P < .001). Telehealth visits were less time-consuming from both a patient (P < .001) and physician (P = .002) perspective. Telehealth visits also required less time off work for both patients (P = .001) and caregivers (P < .001). CONCLUSION Patients undergoing arthroscopic rotator cuff surgery were able to receive safe and effective early postoperative follow-up care using telemedicine. The preference for telehealth increased for both surgeons and patients following first-hand experience. The use of a telehealth platform is a reasonable follow-up model to consider for patients seeking convenient and efficient care following arthroscopic rotator cuff repair.
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Affiliation(s)
- Liam T Kane
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Ocean Thakar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Grant Jamgochian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mark D Lazarus
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - John G Horneff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
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10
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Xu S, Chen JY, Lie HME, Hao Y, Lie DTT. Minimal Clinically Important Difference of Oxford, Constant, and UCLA shoulder score for arthroscopic rotator cuff repair. J Orthop 2019; 19:21-27. [PMID: 32021030 DOI: 10.1016/j.jor.2019.11.037] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022] Open
Abstract
Aim To determine the Minimal Clinically Important Difference (MCID) for Constant-Murley score (CMS), University of California Los Angeles (UCLA) shoulder score, and Oxford Shoulder Scores (OSS) after arthroscopic rotator cuff (RC) repairs. Material and methods 306 patients were followed up for 24-month. MCID for CMS, UCLA and OSS were determined using simple linear regression according to patient satisfaction and expectation fulfilment. Results The following MCID were identified:12-month: CMS 6.7, UCLA 3.0, OSS 3.3.24-month: CMS 6.3, UCLA 2.9, OSS 2.7. Conclusions The various MCID could assist in meaningful interpretation of these scores and to power future comparative studies. Level of evidence III.
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Affiliation(s)
- Sheng Xu
- Singapore General Hospital, Department of Orthopedic Surgery, Singapore
| | | | - Hannah Mei En Lie
- Singapore General Hospital, Department of Orthopedic Surgery, Singapore
| | - Ying Hao
- Singapore General Hospital, Health Service Research Institute, Singapore
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11
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Exploring the Business Case for Improving Quality of Care for Patients With Chronic Rotator Cuff Tears. Qual Manag Health Care 2019; 28:209-221. [PMID: 31567844 DOI: 10.1097/qmh.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, management of patients presenting with chronic rotator cuff tears in Alberta is in need of quality improvements. This article explores the potential impact of a proposed care pathway whereby all patients presenting with chronic rotator cuff tears in Alberta would adopt an early, conservative management plan as the first stage of care; ultrasound investigation would be the preferred tool for diagnosing a rotator cuff tear; and only patients are referred for surgery once conservative measures have been exhausted. METHODS We evaluate evidence in support of surgery and conservative management, compare care in the current state with the proposed care pathway, and identify potential solutions in moving toward optimal care. RESULTS A literature search resulted in an absence of indications for either surgical or conservative management. Conservative management has the potential to reduce utilization of public health care resources and may be preferable to surgery. The proposed care pathway has the potential to avoid nearly Can $87 000 in public health care costs in the current system for every 100 patients treated successfully with conservative management. CONCLUSION The proposed care pathway is a low-cost, first-stage treatment that is cost-effective and has the potential to reduce unnecessary, costly surgical procedures.
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12
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The primary cost drivers of arthroscopic rotator cuff repair surgery: a cost-minimization analysis of 40,618 cases. J Shoulder Elbow Surg 2019; 28:1977-1982. [PMID: 31202627 DOI: 10.1016/j.jse.2019.03.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND An estimated 250,000 rotator cuff repair (RCR) surgical procedures are performed every year in the United States. Although arthroscopic RCR has been shown to be a cost-effective operation, little is known about what specific factors affect the overall cost of surgery. This study examines the primary cost drivers of RCR surgery in the United States. METHODS Univariate analysis was performed to determine the patient- and surgeon-specific variables for a multiple linear regression model investigating the cost of RCR surgery. The 2014 State Ambulatory Surgery and Services Databases were used, yielding 40,618 cases with Current Procedural Terminology code 29827 ("arthroscopic shoulder rotator cuff repair"). RESULTS The average cost of RCR surgery was $25,353. Patient-specific cost drivers that were significant under multiple linear regression included black race (P < .001), presence of at least 1 comorbidity (P < .001), income quartile (P < .001), male sex (P = .012), and Medicare insurance (P = .035). Surgical factors included operative time (P < .001), use of regional anesthesia (P < .001), quarter of the year (January to March, April to June, July to September, and October to December) (P < .001), concomitant subacromial decompression or distal clavicle excision (P < .001), and number of suture anchors used (P < .001). The largest cost driver was subacromial decompression, adding $4992 when performed alongside the RCR. CONCLUSION There are several patient-specific variables that can affect the cost of RCR surgery. There are also surgeon-controllable factors that significantly increase cost, most notably subacromial decompression, distal clavicle excision, use of regional anesthesia, and number of suture anchors. Surgeons must consider these factors in an effort to minimize cost, particularly as bundled payments become more common.
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Day MA, Westermann RW, Bedard NA, Glass NA, Wolf BR. Trends Associated with Open Versus Arthroscopic Rotator Cuff Repair. HSS J 2019; 15:133-136. [PMID: 31327943 PMCID: PMC6609773 DOI: 10.1007/s11420-018-9628-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff (RTC) repair is performed using open/mini-open or arthroscopic procedures, and the use of arthroscopic techniques is increasing. The extent to which surgery has transitioned from open to arthroscopic techniques has yet to be elucidated. QUESTIONS/PURPOSES The purpose of this study was to evaluate trends in open and arthroscopic rotator cuff repair in the USA and describe tendencies in treatment across gender, age, and geographic region. We hypothesized that surgeons would be more likely to perform arthroscopic rotator cuff repair, with similar trends across the USA. METHODS A retrospective review of a comprehensive national insurance database (Humana) was performed using the PearlDiver software for all patients who underwent RTC repair between January 2007 and June 2015. Patients were identified by Current Procedural Terminology (CPT) codes. χ 2 tests evaluated the proportion of arthroscopic surgeries by gender and geographic region; logistic regression analysis assessed differences from 2007 to 2015. RESULTS In the study period, 54,740 patients underwent RTC repair (68% arthroscopic, 52% male), with the highest frequency of RTC repair in patients between 65 and 69 years old. The proportion of open RTC repair increased with increasing patient age, with no significant difference between men and women. The proportion of arthroscopic RTC surgeries increased from 56.9% in 2007 to 75.1% in 2015. The overall trend was 188% increase in total RTC repairs. Arthroscopic repair was more frequent than open repair in all US regions, with the highest proportion in the South. CONCLUSION Arthroscopic RTC surgery predominates and continues to rise. With increasing patient age, there was an increase in the proportion of open repair. The majority of RTC repairs were performed in patients between 65 and 69 years of age.
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Affiliation(s)
- Molly A. Day
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Robert W. Westermann
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Nicholas A. Bedard
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Natalie A. Glass
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Brian R. Wolf
- 0000 0004 0434 9816grid.412584.eDepartment of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
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Witney-Lagen C, Mazis G, Bruguera J, Atoun E, Sforza G, Levy O. Do elderly patients gain as much benefit from arthroscopic rotator cuff repair as their younger peers? J Shoulder Elbow Surg 2019; 28:1056-1065. [PMID: 30704915 DOI: 10.1016/j.jse.2018.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was conducted to ascertain whether patients aged older than 75 years achieve outcomes after arthroscopic rotator cuff repair comparable to younger patients. METHODS Arthroscopic cuff repair was performed in 60 shoulders of 59 patients aged older than 75 years. A control group of 60 younger patients, matched for sex, tear size, and American Society of Anesthesiology Functional Classification grade were included. Surgery occurred from 2006 to 2016. Prospective outcomes were the Constant score (CS), Subjective Shoulder Value, pain, satisfaction, and operative complications. Mean follow-up was 29 months. RESULTS The elderly group was a mean age of 78 years compared with 59 years for controls. Tear sizes were 25 massive, 20 large, 12 medium, and 3 small. The CS improved by 25.1 points in elderly patients compared with 23.7 points for controls (P = .742). Pain improved by 7.5 of 15 in elderly patients vs. 6.2 of 15 in controls (P = .055). Fifty-five of 59 older patients were satisfied compared with 52 of 60 controls (P = .378). The overall complication rate did not differ between the groups (P = .509). Both groups had 1 infection and 1 stiffness. An acromioclavicular joint cyst developed in 1 younger patient, and a traumatic retear occurred in 1 patient. Subsequent reverse total shoulder arthroplasty was performed in 4 elderly patients at a mean of 28 months after cuff repair. Massive tears had higher risk for subsequent reverse total shoulder arthroplasty (P = .026). CONCLUSION Elderly patients benefit as much from arthroscopic rotator cuff repair as their younger counterparts. Similar improvements in CS, Subjective Shoulder Value, pain, and satisfaction occurred for both elderly and control patients. Arthroscopic repair was safe and effective in both groups. Even elderly patients with massive tears showed clinically significant improvements. Arthroscopic rotator cuff repair should be considered as a valuable treatment irrespective of age.
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Affiliation(s)
- Caroline Witney-Lagen
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Georgios Mazis
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
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Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
| | - S A Corbett
- Guy's and St Thomas' NHS Foundation Trust and Fortius Clinic, London, UK
| | - N C Hatrick
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - T D Tennent
- St George's University Hospitals NHS Foundation Trust and Professor of Orthopaedic Education, St. George's University of London, London, UK
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Piuzzi NS, Ng M, Song S, Bigach S, Khlopas A, Salas-Vega S, Mont MA. Consolidation and maturation of the orthopaedic medical device market between 1999 and 2015. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:759-766. [PMID: 30627923 DOI: 10.1007/s00590-019-02372-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022]
Abstract
Orthopaedic surgeons often require highly specialized medical devices, implants, and equipment, which are usually offered by several vendors/companies. This study assesses long-term market trends for orthopaedic medical device companies and examines various implications for healthcare cost. Using S&P Capital IQ, a Wall Street database, financial data were gathered on orthopaedic device companies, ranked by worldwide sales, from 1999 to 2015. Annual sales were aggregated to calculate market share and compounded annual growth rates (CAGRs). Overall, the global orthopaedic device market grew at 12.0% CAGR from 1999 to 2008, before slowing to 2.8% from 2009 to 2015. Between 1999 and 2015, the top 5 companies increased total market share from 52.8 to 62.2%. The orthopaedic device market is not only consolidating under a few dominant players, but also growing at a decreasing rate, both of which signal a maturing industry. These trends are likely to shape patient care and healthcare costs in orthopaedic surgery in years to come.
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Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
- Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Mitchell Ng
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Simon Song
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Stephen Bigach
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | | | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA
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18
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Jensen AR, Cha PS, Devana SK, Ishmael C, Di Pauli von Treuheim T, D'Oro A, Wang JC, McAllister DR, Petrigliano FA. Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population. Orthop J Sports Med 2017; 5:2325967117731310. [PMID: 29051905 PMCID: PMC5639972 DOI: 10.1177/2325967117731310] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Medicare insures the largest population of patients at risk for rotator cuff tears in the United States. Purpose: To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients. Study Design: Cohort study; Level of evidence, 3. Methods: All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups. Results: In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01). Conclusion: In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs.
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Affiliation(s)
- Andrew R Jensen
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Peter S Cha
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Sai K Devana
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Chad Ishmael
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
| | | | - Anthony D'Oro
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California, USA
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Jacofsky DJ, Haddad FS. The reform of methods of payment for orthopaedic services. Bone Joint J 2017; 99-B:1265-1266. [PMID: 28963145 DOI: 10.1302/0301-620x.99b10.bjj-2017-1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/05/2022]
Affiliation(s)
- D J Jacofsky
- The CORE Institute, 18444 N. 25th Avenue, Phoenix, AZ, USA
| | - F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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