What Does a Shoulder MRI Cost the Consumer?

Westermann, Robert W.; Schick, Cameron W.; Graves, Christopher; Duchman, Kyle R.; Weinstein, Stuart L.

doi:10.1007/s11999-016-5181-9

Cited by 18 publications

(12 citation statements)

References 22 publications

(22 reference statements)

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“…In terms of cost-effectiveness, biomarkers are in general cost-effective in comparison to the gold standard method using radiological imaging such as MRI ( 79 , 80 ). An MRI needs to be made pre- and postoperatively to objectively assess the development of the soft tissue after a procedure.…”

Section: Discussionmentioning

confidence: 99%

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

et al. 2022

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BackgroundThere is a trend toward minimally invasive and more automated procedures in orthopedic surgery. An important aspect in the further development of these techniques is the quantitative assessment of the surgical approach. The aim of this scoping review is to deliver a structured overview on the currently used methods for quantitative analysis of a surgical approaches' invasiveness in orthopedic procedures. The compiled metrics presented in the herein study can serve as the basis for digitization of surgery and advanced computational methods that focus on optimizing surgical procedures.MethodsWe performed a blinded literature search in November 2020. In-vivo and ex-vivo studies that quantitatively assess the invasiveness of the surgical approach were included with a special focus on radiological methods. We excluded studies using exclusively one or multiple of the following parameters: risk of reoperation, risk of dislocation, risk of infection, risk of patient-reported nerve injury, rate of thromboembolic event, function, length of stay, blood loss, pain, operation time.ResultsThe final selection included 51 articles. In the included papers, approaches to 8 different anatomical structures were investigated, the majority of which examined procedures of the hip (57%) and the spine (29%). The different modalities to measure the invasiveness were categorized into three major groups “biological” (23 papers), “radiological” (25), “measured in-situ” (14) and their use “in-vivo” or “ex-vivo” was analyzed. Additionally, we explain the basic principles of each modality and match it to the anatomical structures it has been used on.DiscussionAn ideal metric used to quantify the invasiveness of a surgical approach should be accurate, cost-effective, non-invasive, comprehensive and integratable into the clinical workflow. We find that the radiological methods best meet such criteria. However, radiological metrics can be more prone to confounders such as coexisting pathologies than in-situ measurements but are non-invasive and possible to perform in-vivo. Additionally, radiological metrics require substantial expertise and are not cost-effective. Owed to their high accuracy and low invasiveness, radiological methods are, in our opinion, the best suited for computational applications optimizing surgical procedures. The key to quantify a surgical approach's invasiveness lies in the integration of multiple metrics.

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Section: Discussionmentioning

confidence: 99%

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

et al. 2022

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“…MRI of the shoulder accounts for two-thirds of nonsurgical costs in management of rotator cuff tears, and the cost to patients and payors can be thousands of dollars. 13,25,26 Conversely, Mather et al 10 estimated that operative management of rotator cuff tears leads to an average of $13,771 in lifetime savings compared to nonoperative management, with this increasing to over $70,000 in younger patients. Furthermore, surgical management has been associated with an increase in QALYs for patients.…”

Section: Discussionmentioning

confidence: 99%

The importance of surgeon judgment in obtaining early magnetic resonance imaging to prevent delays in care for acute subacromial injury: a retrospective comparative cohort study

Stevens

Hartline

Brolin

et al. 2022

Current Orthopaedic Practice

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Background:The purpose of this study was to evaluate the role of initial assessment of acute subacromial injury by an orthopaedic surgeon to identify surgical lesions that would benefit from early imaging. Methods:Patients with subacromial injury were identified. Patients who had MRI ordered at the initial visit for suspicion of a surgical lesion comprised the study group. The remaining patients were treated conservatively. Results:A total of 367 patients were identified; 298 (81%) underwent conservative treatment, 84 of whom had later MRI, and 69 (19%) had an MRI ordered initially. In the early MRI group, 31 (44.9%) underwent surgery an average of 85 days from presentation compared to 38 (12.8%) in the conservative group who underwent surgery 140 days from presentation (P = 0.019). MRI scan review revealed that 41/69 (59.4%) patients in the early MRI group had full-thickness rotator cuff tear compared with 33/84 (39.3%) in the conservative group with MRI (P = 0.020). Partialthickness tears were noted in 8/69 (11.6%) in the early MRI group. In the conservative group that subsequently had MRI, 17/84 (20.2%) had a partial-thickness tear. Conclusions:Nearly 60% of patients undergoing initial MRI based on orthopaedic surgeon judgment had a full-thickness rotator cuff tear, significantly more than patients treated conservatively upon initial evaluation. Patients who first undergo conservative treatment for suspected acute subacromial injury experience a significant delay both in MRI and surgical intervention. Surgeon judgment is an important factor in the decision to obtain MRI in acute subacromial injury to prevent delays in care.

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“…MRI evaluation is common practice for orthopaedic surgeons and MSK radiologists; therefore, evaluating the reproducibility of MRI for diagnosing supraspinatus partial-thickness tears is important for determining the reliability of this diagnostic test [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging reproducibility for rotator cuff partial tears in patients up to 60 years

Yazigi

Nicolao

Netto

et al. 2019

BMC Musculoskelet Disord

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Background Magnetic resonance imaging (MRI) is the gold standard in diagnosing rotator cuff pathology; however, there is a lack of studies investigating the reliability agreement for supraspinatus partial-thickness tears among orthopaedic surgeons and musculoskeletal (MSK) radiologists. Methods Sixty digital MRI scans (1.5 Tesla) were reviewed by two orthopaedic shoulder surgeons, two MSK radiologists, two fellowship-trained shoulder surgeons, and two fellowship-trained orthopaedic surgeons at two distinct times. Thirty-two scans of partial-thickness tears and twenty-eight scans of the supraspinatus tendon with no tears were included. Supraspinatus tendonosis and tears, long head of the biceps pathology, acromial morphology, acromioclavicular joint pathology and muscle fatty infiltration were assessed and interpreted according to the Goutallier system. After a four-week interval, the evaluators were asked to review the same scans in a different random order. The statistical analyses for the intra- and interobserver agreement results were calculated using the kappa value and 95% confidence intervals. Results The intraobserver agreement for supraspinatus tears was moderate among the MSK radiologists (k = 0.589; 95% CI, 0.446–0.732) and the orthopaedic shoulder surgeons (k = 0.509; 95% CI, 0.324–0.694) and was fair among the fellowship-trained shoulder surgeons (k = 0.27; 95% CI, 0.048–0.492) and the fellowship-trained orthopaedic surgeons (k = 0.372; 95% CI, 0.152–0.592). The overall intraobserver agreement was good (k = 0.627; 95% CI, 0.576–0.678). The intraobserver agreement was moderate for biceps tendonosis (k = 0.491), acromial morphology (k = 0.526), acromioclavicular joint arthrosis (k = 0.491) and muscle fatty infiltration (k = 0.505). The interobserver agreement results for supraspinatus tears were fair and poor among the evaluators: the MSK radiologists and the orthopaedic shoulder surgeons had the highest agreement (k = 0.245; 95% CI, 0.055–0.435). Conclusions In this sample of digital MRI scans, there was an overall good intraobserver agreement for supraspinatus partial tears; however, there were also poor and fair interobserver agreement results. The evaluators with higher levels of experience (the orthopaedic shoulder surgeons and the MSK radiologists) demonstrated better results than evaluators with lower levels of experience. Electronic supplementary material The online version of this article (10.1186/s12891-019-2760-4) contains supplementary material, which is available to authorized users.

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What Does a Shoulder MRI Cost the Consumer?

Cited by 18 publications

References 22 publications

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

The importance of surgeon judgment in obtaining early magnetic resonance imaging to prevent delays in care for acute subacromial injury: a retrospective comparative cohort study

Magnetic resonance imaging reproducibility for rotator cuff partial tears in patients up to 60 years

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