A new national study found racial, ethnic and socioeconomic disparities in shoulder arthroscopy, a procedure that is increasingly performed in ambulatory surgery centers (ASCs).
Researchers analyzed the 2019 Nationwide Ambulatory Surgery Sample and estimated that 340,892 shoulder arthroscopies were performed across the country that year, with an average charge of $32,910.
“There are well-defined disparities in the use of orthopaedic surgery among different patient populations in the United States,” the study authors wrote. “These trends must be closely analyzed to help define their effect on the disparities experienced by disadvantaged populations.”
Most patients were white, making up 80%of the total. Men accounted for 57%, and 78% of patients were over the age of 45. The most common reasons for surgery were rotator cuff injury at 60%, labral tear at 8% and impingement syndrome at 8%.
The study found clear differences in how often patients received surgery. White patients had a utilization rate of 138.7 procedures per 100,000 people. That compared with 73.0 for Black patients, 50.7 for Hispanic patients, and 36.5 for Asian or Pacific Islander patients.
“These disparities persisted across indications such as rotator cuff repair and shoulder instability, suggesting systemic barriers beyond clinical need,” the authors wrote.
Socioeconomic factors contributed to the gaps. Black and Hispanic patients were more likely to live in low-income areas and to rely on Medicaid coverage. White patients, meanwhile, were more likely to have surgery at smaller, nonteaching facilities, while non-white patients more often had procedures at larger, teaching hospitals.
The study also found disparities in cost. White patients faced average charges of $32,183, compared with $35,474 for non-White patients. For rotator cuff repair, white patients were charged about $34,438 compared with $37,175 for non-white patients. For shoulder instability, charges averaged $32,568 for white patients and $35,732 for non-White patients.
Geography played a role as well. Patients in the Northeast and Midwest faced average charges of $28,657, while patients in the South and West were charged $36,309. Investor owned hospitals billed far more than public or nonprofit facilities, with an average of $44,846 per procedure.
“As procedures shift to ASCs, disparities in access and charges could be magnified if structural barriers are not addressed,” researchers wrote.
