Rotator Cuff Injuries and Tears

•   What's the rotator cuff? The rotator cuff is a small grouping of muscles and tendons that work together to stabilize the shoulder and allow it to move in different directions.

•   What are typical causes of rotator cuff injuries? Roughly 4.5 million patient visits occur yearly in the United States regarding shoulder pain, and rotator cuff injuries are among the most common causes.  The rotator cuff can become worn down and deteriorate due to aging or trauma (like falling and injuring the shoulder or excessive use in sports).

•   How is rotator cuff injury treated? The worst type of rotator cuff injuries frequently require surgery to fix the harm. These treatments can be performed by either arthroscopy or open surgery, and involve mending the torn rotator cuff by suturing the muscle tissues back together. Recovery from surgery many times needs prolonged physical therapy and rehabilitation. In less severe injuries, physical therapy and/or rehabilitation, at-home exercises and medication for pain are examples of common treatment programs.

•   What is the purpose of the investigation on societal savings and why's it important? The affect of rotator cuff tears on income, skipped work days, and disability payments was basically unknown, which is the reason why the American Academy of Orthopaedic Surgeons (AAOS) put together this study. It examines the value of surgical procedure for full thickness rotator cuff tears coming from a societal perspective, including the costs and advantages to patients, employers, payers, as well as the government. Rotator cuff injuries can affect anybody, but danger grows with age. The social stress of rotator cuff tears is potentially significant, considering their effect on people’s capacity to work and stay successful.

•   What data was utilized to assess the economic value of rotator cuff surgery and how was it analyzed? Model assumptions were obtained from literature review and an analysis of Medicare claims data, and data from the State Ambulatory Surgery Databases (SASD) for a sample of states. Estimates of secondary costs were obtained from an analysis of the National Health Interview Survey (NHIS) and patient outcomes data from a multi-practice orthopaedic surgery team.  Results from the analysis were utilized in a Markov Decision Model, a standard predictive tool that accounts for a number of possible outcomes.  Four indirect cost elements were modeled: likelihood of employment, household income, lost work days, and disability payments.  Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population and effectiveness was expressed in quality adjusted life years (QALYs).

•   What did the investigation conclude? In comparing surgical repair and non-operative therapy, the study found that surgical treatment for rotator cuff tears reduces indirect costs and more than offsets the direct costs of treatment in patients below age 61, producing a net savings to society. The study determined there was an estimated lifetime societal savings of about $3.44 billion from the roughly 250,000 rotator cuff repairs performed in the United States. The age-weighted mean total societal savings per person from rotator cuff repair, compared with non-surgical treatment, was $13,771 (2012 dollars).

•   How will the study be utilized in the long term and what's its affect on health care costs? This is the first study to analyze the total societal impact of rotator cuff tears and its prospective treatments. This research model offers a foundation for determining the value of procedures and health services, and in the future can be applied to other medical specialties past those mentioned previously to ultimately decrease surplus health care spending.

I want to thank Dr. Weaver and her surgical staff.  We… are blessed to have such high quality health care…

P&J. A.