AAOS Appropriate Use Criteria: Optimizing the Management of Full-Thickness Rotator Cuff Tears

Pappou, Ioannis P.; Schmidt, Christopher C.; Jarrett, Claudius D.; Steen, Brandon; Frankle, Mark A.

doi:10.5435/jaaos-21-12-772

Cited by 15 publications

(11 citation statements)

References 4 publications

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“…Atraumatic rotator cuff tear is a frequent cause of shoulder pain and dysfunction in the population over 60 years of age and is present in up to 49.4% of patients with a history of shoulder complaints 2 . Symptomatic atraumatic rotator cuff tear is associated with functional limitation that can affect activities of daily living, sleep patterns, and overall quality of life 3 - 5 . Direct costs associated with surgical repair alone exceed $1.5 billion annually in the United States 4 - 7 .…”

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confidence: 99%

Treatment for Rotator Cuff Tear Is Influenced by Demographics and Characteristics of the Area Where Patients Live

Chapman

Floyd

Thigpen

et al. 2018

JBJS OA

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Background:Atraumatic rotator cuff tear is a common orthopaedic complaint for people >60 years of age. Lack of evidence or consensus on appropriate treatment for this type of injury creates the potential for substantial discretion in treatment decisions. To our knowledge, no study has assessed the implications of this discretion on treatment patterns across the United States.Methods:All Medicare beneficiaries in the United States with a new magnetic resonance imaging (MRI)-confirmed atraumatic rotator cuff tear were identified with use of 2010 to 2012 Medicare administrative data and were categorized according to initial treatment (surgery, physical therapy, or watchful waiting). Treatment was modeled as a function of the clinical and demographic characteristics of each patient. Variation in treatment rates across hospital referral regions and the presence of area treatment signatures, representing the extent that treatment rates varied across hospital referral regions after controlling for patient characteristics, were assessed. Correlations between measures of area treatment signatures and measures of physician access in hospital referral regions were examined.Results:Among patients who were identified as having a new, symptomatic, MRI-confirmed atraumatic rotator cuff tear (n = 32,203), 19.8% were managed with initial surgery; 41.3%, with initial physical therapy; and 38.8%, with watchful waiting. Patients who were older, had more comorbidity, or were female, of non-white race, or dual-eligible for Medicaid were less likely to receive surgery (p < 0.0001). Black, dual-eligible females had 0.42-times (95% confidence interval [CI], 0.34 to 0.50) lower odds of surgery and 2.36-times (95% CI, 2.02 to 2.70) greater odds of watchful waiting. Covariate-adjusted odds of surgery varied dramatically across hospital referral regions; unadjusted surgery and physical therapy rates varied from 0% to 73% and from 6% to 74%, respectively. On average, patients in high-surgery areas were 62% more likely to receive surgery than the average patient with identical measured characteristics, and patients in low-surgery areas were half as likely to receive surgery than the average comparable patient. The supply of orthopaedic surgeons and the supply of physical therapists were associated with greater use of initial surgery and physical therapy, respectively.Conclusions:Patient characteristics had a significant influence on treatment for atraumatic rotator cuff tear but did not explain the wide-ranging variation in treatment rates across areas. Local-area physician supply and specialty mix were correlated with treatment, independent of the patient’s measured characteristics.

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confidence: 99%

Treatment for Rotator Cuff Tear Is Influenced by Demographics and Characteristics of the Area Where Patients Live

Chapman

Floyd

Thigpen

et al. 2018

JBJS OA

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“…27,29,33,[50][51][52] However, the AUC did not specifically consider the temporal relationship between time of injury and need for repair. 36,39 As a surrogate, the age of the tear was inferred from the amount of fatty Full-thickness rotator cuff tears: AUC infiltration. The weakness in using fatty infiltration to quantify tear age is that structural changes in the rotator cuff muscle are variable and can take up to 1 to 3 years to develop.…”

Section: Discussionmentioning

confidence: 99%

“…36,39 The methodology is reviewed in Figure 1. Briefly, combinations of patient and disease factors (Tables I and II) were considered in determining the appropriateness of 5 different treatment possibilities (Table III).…”

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confidence: 99%

“…This combination of different patient and disease factors and treatment options yielded 432 unique clinical scenarios (www.aaos.org/aucapp). 36,39 Finally, the level of ''appropriateness'' was stratified into three groups: (1) appropriate: benefits outweigh risks, (2) maybe appropriate: benefits equal risks, and (3) rarely appropriate: risks outweigh benefits (Table III). 36 The voting panel (70% orthopedists and 30% nonorthopedists) then attributed a level of appropriateness for a given treatment to each patient scenario.…”

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Management of full-thickness rotator cuff tears: appropriate use criteria

Schmidt

Morrey

2015

Journal of Shoulder and Elbow Surgery

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“…1,2 The level of appropriateness was ranked into three groups: 1. The AUC methodology consisted of writing, review, and voting panels that created 432 unique patient scenarios and graded the 5 above treatment options for each scenario.…”

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confidence: 99%

Full Thickness Rotator Cuff Tears Summary Recommendations of the Appropriate Use Criteria

Schmidt¹,

Morrey²,

Murray³

2015

Journal of Shoulder and Elbow Surgery

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AAOS Appropriate Use Criteria: Optimizing the Management of Full-Thickness Rotator Cuff Tears

Cited by 15 publications

References 4 publications

Treatment for Rotator Cuff Tear Is Influenced by Demographics and Characteristics of the Area Where Patients Live

Treatment for Rotator Cuff Tear Is Influenced by Demographics and Characteristics of the Area Where Patients Live

Management of full-thickness rotator cuff tears: appropriate use criteria

Full Thickness Rotator Cuff Tears Summary Recommendations of the Appropriate Use Criteria

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