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Editorial Commentary: Complications of Shoulder Rotator Cuff Repair Are Relevant in Modern Health Care

      Abstract

      Understanding the type and rate of complications after shoulder rotator cuff repair could help surgeons to focus their quality improvement efforts. This is of great current relevance because value in health care is defined as the ratio of outcomes over cost, and complications increase cost significantly. A particular focus could be on lowering the rate of complications associated with “riskier” patients and “riskier” surgical techniques.
      I enjoyed reading the study titled “Risk Factors for Short-term Complications After Rotator Cuff Repair in the United States” by Schairer, Nwachukwu, Fu, Warren.
      • Schairer W.W.
      • Nwachukwu B.U.
      • Fu M.C.
      • Warren R.F.
      Risk factors for short-term complications after rotator cuff repair in the United States.
      This study is very relevant to the current issues in modern health care delivery. The data it provides will allow health care providers and hospital systems to develop mechanisms and pathways of cost-efficient care delivery for patients with rotator cuff disease.
      The number of rotator cuff repairs performed each year is increasing, and this upward trend is projected to continue.
      • Ensor K.L.
      • Kwon Y.W.
      • Dibeneditto M.R.
      • Zuckerman J.D.
      • Rokito A.S.
      The rising incidence of rotator cuff repairs.
      • Kim S.H.
      • Wise B.L.
      • Zhang Y.
      • Szabo R.M.
      Increasing incidence of shoulder arthroplasty in the United States.
      Accurately defining the most common complications after rotator cuff repair surgery is important for patient counseling and quality improvement initiatives. The costs of health care have been rising dramatically, and controlling the rise of health care costs is one of the top priorities of our nation.
      • Hamid K.S.
      • Nwachukwu B.U.
      • Poehling G.G.
      Lights, camera, action: How to make arthroscopy a star in value-based health care.
      The government is devising mechanisms to control the costs of health care by rewarding value, which is the ratio of outcomes over cost.
      • Porter M.E.
      • Teisberg E.O.
      Redefining health care: Creating value-based competition on results.
      Complications are one of the major drivers of cost.
      • Warner J.P.
      • Higgines L.D.
      Editorial commentary: Volume and outcome: 100 years of perspective on value from E.A. Codman to M.E. Porter.
      Thus, knowing the risks that drive complication rates up is important to try to prevent them. One of the mechanisms being instituted currently to reward value is creation of bundles for episodes of care. One of the major challenges of devising bundles of care is risk stratification of patients. Risk stratification is important to account for “riskier” patients and procedures that bear higher costs of care. It is also important to understand modifiable risks because better pathways of care may be implemented to improve outcomes and thus lessen the cost of care.
      The federal government has also been trying to control health care costs through nonreimbursable “never events,” and decreasing payment for readmissions within 30 days after joint arthroplasty.
      • Bozic K.J.
      • Ward L.
      • Vail T.P.
      • Maze M.
      Bundled payments in total joint arthroplasty: Targeting opportunities for quality improvement and cost reduction.
      • Lembitz A.
      • Clarke T.J.
      Clarifying “never events” and introducing “always events”.
      • Mahoney A.
      • Bosco III, J.A.
      • Zuckerman J.D.
      Readmission after shoulder arthroplasty.
      Expansion of all these measures to more areas of orthopaedic surgery, inpatient and outpatient, along with the participation of private insurance companies should be anticipated.
      • Mahoney A.
      • Bosco III, J.A.
      • Zuckerman J.D.
      Readmission after shoulder arthroplasty.
      Because the government has decided complications in the first 30 days after surgery will be their measure for quality of care, efforts to decrease complications during the 30-day perioperative period should be a major focus.
      The strength of this study is that it uses a large national database to identify patient factors that increase the risk for major complications within 30 days after rotator cuff repair. I agree with the authors that the existing literature is lacking information on 30-day complication rates specifically for rotator cuff repair. The study reports the rates of several frequent complications and will allow surgeons to focus their quality improvement initiatives on lowering complication rates. Moreover, rotator cuff surgeons could focus on lowering the rate of complications associated with “riskier” patients and “riskier” surgical techniques.

      Supplementary Data

      References

        • Schairer W.W.
        • Nwachukwu B.U.
        • Fu M.C.
        • Warren R.F.
        Risk factors for short-term complications after rotator cuff repair in the United States.
        Arthroscopy. 2018; 34: 1158-1163
        • Ensor K.L.
        • Kwon Y.W.
        • Dibeneditto M.R.
        • Zuckerman J.D.
        • Rokito A.S.
        The rising incidence of rotator cuff repairs.
        J Shoulder Elbow Surg. 2013; 22: 1628-1632
        • Kim S.H.
        • Wise B.L.
        • Zhang Y.
        • Szabo R.M.
        Increasing incidence of shoulder arthroplasty in the United States.
        J Bone Joint Surg Am. 2011; 93: 2249-2254
        • Hamid K.S.
        • Nwachukwu B.U.
        • Poehling G.G.
        Lights, camera, action: How to make arthroscopy a star in value-based health care.
        Arthroscopy. 2013; 29: 1900-1901
        • Porter M.E.
        • Teisberg E.O.
        Redefining health care: Creating value-based competition on results.
        Harvard Business School Press, Boston2006
        • Warner J.P.
        • Higgines L.D.
        Editorial commentary: Volume and outcome: 100 years of perspective on value from E.A. Codman to M.E. Porter.
        Arthroscopy. 2017; 33: 1282-1285
        • Bozic K.J.
        • Ward L.
        • Vail T.P.
        • Maze M.
        Bundled payments in total joint arthroplasty: Targeting opportunities for quality improvement and cost reduction.
        Clin Orthop Relat Res. 2014; 472: 188-193
        • Lembitz A.
        • Clarke T.J.
        Clarifying “never events” and introducing “always events”.
        Patient Saf Surg. 2009; 3: 26
        • Mahoney A.
        • Bosco III, J.A.
        • Zuckerman J.D.
        Readmission after shoulder arthroplasty.
        J Shoulder Elbow Surg. 2014; 23: 377-381

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