Shoulder stabilization surgeries incurred greater cost initially, preventing subsequent dislocations allows for cost savings starting as early as the third ED presentation for shoulder dislocation.
Shoulder instability can be a costly problem with a high potential for recurrent instability following initial dislocation based on well-established patient characteristics. Patients with recurrent instability can be treated with shoulder stabilizing procedures. Though more costly on the front end, surgery may decrease the overall healthcare burden of managing a patient with multiple shoulder dislocations nonoperatively. We compared and evaluated healthcare costs associated with non-surgical and surgical management of patients who experience single or multiple episodes of shoulder dislocation.
Retrospective chart review of patients who presented to the ED with a diagnosis of a shoulder dislocation at a Level 1 academic trauma center during the year 2016. Chart review was performed to identify patient information about the current dislocation, past dislocations, shoulder surgery, and post reduction follow-up. This data was then used to determine the average cost of ED presentation for a shoulder dislocation for a non-patient specific episode as obtained from the hospital financial department. The cost of shoulder stabilization procedures was also obtained for comparison purposes for cost-benefit analysis.
Data was collected on 103 individuals who presented to the ED with shoulder dislocations. Of these 63 were primary dislocations and 40 were repeat dislocations. Twelve patients underwent shoulder stabilization surgery following their ED presentation. Average cost to the institution for closed reduction of a shoulder dislocation was $1,218 ($973 without sedation and $3,744 with conscious sedation). Average cost of a shoulder stabilization procedure done at this same institution was $7,807 ($7,852 for Latarjet and $7,784 for Bankart repair).
Discussion And Conclusion
Though shoulder stabilization surgeries incurred greater cost initially, preventing subsequent dislocations allows for cost savings starting as early as the third ED presentation for shoulder dislocation. These findings suggest that if patients are at a high risk of recurrent instability there may be cost-savings benefits from early stabilization surgery.