Reimbursement, efficiency, and safety in rotator cuff repair: a comparative study of arthroscopic and open approaches

Background: Rotator cuff repair (RCR) is one of the most common orthopedic procedures in the United States. Although arthroscopic and open RCR yield similar long-term outcomes, differences in reimbursement and short-term safety are less understood. This study aimed to evaluate differences between RCR techniques in work relative value units (wRVUs), operative times, Medicare reimbursement amounts, and 30-day complication rates. Methods: To data collection, the National Surgical Quality Improvement Program database was retrospectively analyzed (2006-2023). Patients undergoing arthroscopic or open RCR were identified by Current Procedural Terminology codes and matched 1:1 via propensity score matching according to demographics and comorbidities. Outcomes included operative time, wRVUs, Medicare reimbursement amount, and 30-day postoperative complications. Results: A total of 18,988 matched patients (9,494 with arthroscopic RCR, 9,494 with open RCR) were included. Arthroscopic RCR cases had significantly longer operative times than open RCR cases (91.82±43.71 minutes vs. 80.93±41.02 minutes, P<0.001) but generated 17.7% higher wRVUs per minute (0.20±0.09 vs. 0.17±0.07, P<0.001) and 36.0% more revenue per case ($485.20±$0.00 vs. $356.77±$7.54, P<0.001). Arthroscopic RCR patients had significantly lower overall 30-day complication rates (1.1% vs. 1.5%, P=0.010), including fewer superficial (0.2% vs. 0.4%, P=0.023) and deep surgical site infections (0.0% vs. 0.2%, P=0.004). Conclusions: Arthroscopic RCR is associated with lower short-term complication rates than open RCR, despite requiring longer operative times and more resources. This clinical trade-off suggests that the additional operative demands of arthroscopic surgery are justified by the associated improvements in patient safety, highlighting the value of reduced complications as a key advantage of the arthroscopic approach. Level of evidence: III.