Original Article
Demographic Analysis of Open and Arthroscopic Distal Clavicle Excision in a Private Insurance Database

https://doi.org/10.1016/j.arthro.2014.04.088Get rights and content

Purpose

The purpose of this study was to evaluate and quantify the demographic characteristics of patients undergoing open and arthroscopic distal clavicle excision (DCE) in the United States while also describing changes in practice patterns over time.

Methods

Patients who underwent DCE from 2004 to 2009 were identified by Current Procedural Terminology (CPT) codes in a national database of orthopaedic insurance records. The year of procedure, age, sex, geographic region, and concomitant rotator cuff repair or subacromial decompression (SAD) were recorded for each patient. Results were reported as the incidence of procedures identified per 10,000 patients searched in the database.

Results

Between 2004 and 2009, 73,231 DCEs were performed; 74% were arthroscopic and 26% were open. The incidence of arthroscopic DCE increased from 37.8 in 2004 to 58.5 in 2009 (P < .001), whereas the incidence of open DCE decreased from 21.1 in 2004 to 14.1 in 2009 (P < .001). Sixty-one percent of DCEs were performed in men (P < .001). Women were more likely to undergo an arthroscopic procedure (P < .001). Arthroscopic DCE was most common in patients aged 50 to 59 years (P < .001). Open DCE was most common in patients aged 60 to 69 years (P < .001). Open rotator cuff repair and SAD were concomitantly performed in 38% and 23% of open DCEs, respectively. Arthroscopic rotator cuff repair and SAD were concomitantly performed in 33% and 95% arthroscopic DCEs, respectively.

Conclusions

This analysis of DCE using a private insurance database shows that arthroscopic DCEs progressively increased, whereas open DCEs concomitantly decreased between 2004 and 2009. The majority of DCEs were performed in men between the ages of 50 and 59 years. Both arthroscopic and open DCEs are frequently performed in conjunction with rotator cuff repair or SAD.

Level of Evidence

Level IV, cross-sectional study.

Section snippets

Methods

The PearlDiver Patient Record Database (www.pearldiverinc.com; PearlDiver, Warsaw, IN) was used to find all patients who underwent DCE between 2004 and 2009. PearlDiver is an online database of national insurance billing records of patients for whom at least one orthopaedic diagnosis code has been recorded using either the International Classification of Diseases, Ninth Revision (ICD-9) or Current Procedural Terminology (CPT) codes.20 The PearlDiver database was used because it allows a query

Results

Between 2004 and 2009, 11,153,039 patients were identified as having an orthopaedic diagnosis or undergoing an orthopaedic procedure in the PearlDiver Patient Record Database. A total of 73,231 DCEs were performed, which equates to an incidence of 65.7 for every 10,000 patients with an orthopaedic ICD-9 or CPT code. Seventy-four percent (54,170) of these procedures were arthroscopic DCEs, whereas 26.0% (19,061) were open DCEs. Table 1 shows the distribution of DCEs by sex, age, region, and

Discussion

Distal clavicle excision is a proven procedure for the treatment of selected AC pathologic conditions. The purpose of this study was to report the current trends in both open and arthroscopic DCE and the concomitant performance of rotator cuff repair and SAD. In the current analysis, a significant increase in the overall incidence of DCE was observed from 2004 to 2009. Further stratification revealed a significant increase in the arthroscopic approach over that same period, with a significant

Conclusions

This analysis of DCE using a private insurance database found that arthroscopic DCEs progressively increased, whereas open DCEs concomitantly decreased between 2004 and 2009. The majority of DCEs were performed in men between the ages of 50 and 59 years. Both arthroscopic and open DCEs are frequently performed in conjunction with rotator cuff repair or SAD.

References (31)

  • M. Pensak et al.

    Open versus arthroscopic distal clavicle resection

    Arthroscopy

    (2010)
  • R. Sachs et al.

    Open vs. arthroscopic acromioplasty: A prospective, randomized study

    Arthroscopy

    (1994)
  • A. Zhang et al.

    Analysis of rotator cuff repair trends in a large private insurance population

    Arthroscopy

    (2013)
  • E. Mumford

    Acromioclavicular dislocations. A new operative treatment

    J Bone Joint Surg

    (1941)
  • F. Gurd

    The treatment of complete dislocation of the outer end of the clavicle: A hitherto undescribed operation

    Ann Surg

    (1941)
  • Cited by (0)

    The authors report the following potential conflict of interest or source of funding in relation to this article: J.C.W. receives support from North American Spine Society, Cervical Spine Research Society, Collaborative Spine Research Foundation, Arthritis Foundation, Synthes, Biomet, Aesculap, Osprey, Stryker, Alphatech, Amedica, and Seaspine.

    View full text