title: The costs associated with the evaluation of rotator cuff tears before surgical repair.
abstract: BACKGROUND
  Patients undergoing rotator cuff repair typically have a diagnostic evaluation and trial of nonoperative therapy before surgery. Recent studies have evaluated the cost-effectiveness of surgery, but none have attempted to estimate the costs associated with the preoperative evaluation. This study used available data to examine major expenditures during the preoperative period.
  
  
  METHODS
  We conducted a search using an insurance company database to identify patients undergoing rotator cuff repair from 2004 to 2009. Patients were identified by the common Current Procedural Terminology codes for rotator cuff repair. The associated charge codes for the 90-day period before surgery were categorized as outpatient physician visits, diagnostic imaging studies, injections, physical therapy, laboratory and other preoperative studies, prior surgeries, and miscellaneous. The frequency of each code and the associated charges were noted.
  
  
  RESULTS
  In total, 92,688 patients were identified in the study period. A total of $161,993,100 was charged during the preoperative period, for an average of $1,748 per patient. Diagnostic imaging charges totaled $104,510,646 (65%); injections, $5,145,227 (3%); outpatient visits, $29,723,751 (18%); physical therapy, $13,844,270 (8.5%); preoperative studies, $6,792,245 (4.2%); and miscellaneous, $1,164,688 (<1%).
  
  
  CONCLUSIONS
  The costs for preoperative evaluation of rotator cuff tears are substantial, and the majority of the costs are associated with magnetic resonance imaging. To help reduce costs, future studies should attempt to identify the factors that predict which patients might not respond to nonoperative management and might benefit from early surgical intervention. In addition, magnetic resonance imaging should perhaps be reserved for patients in whom the diagnosis cannot be achieved by other modalities.
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Yeranosian
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Terrell
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
authors.forename: David R
authors.initials: DR
authors.lastname: McAllister
authors.forename: Frank A
authors.initials: FA
authors.lastname: Petrigliano
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003952:Diagnostic Imaging / Q000191:economics; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000191:economics; D011300:Preoperative Care / Q000191:economics*; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012785:Shoulder Joint / Q000601:surgery*; D013708:Tendon Injuries / Q000175:diagnosis* / Q000191:economics* / Q000601:surgery
keywords: Economic Analysis; Level IV; Rotator cuff tear; cost analysis; preoperative evaluation