Increasing incidence of rotator cuff surgery: A nationwide registry study in Chile

Background: The rotator cuff surgery (RCS) incidence is rising rapidly in North America, Europe, Asia, and Australia. Despite this, multiple factors limit patients’ access to surgery. In Latin America, barriers to orthopedic surgery have been largely ignored. The purpose of this study was to calculate the rate of RCS in Chile between 2008 and 2018, investigating possible associated factors to access such as age, sex, and the healthcare system. Methods: An ecological study was carried out with nationwide data obtained from the Database of Hospital Discharges of the Department of Statistics. All Chilean inhabitants aged 25 years or more were included. We used the ICD-10 codes M751, M754, and S460. The annual incidence rate of surgeries and the incidence rate for the period studied per 100,000 inhabitants were calculated. Data were analyzed stratified by age, sex, year of study, and the healthcare system. Negative binomial regression was used to compare. Statistical analyzes were performed with Stata v.14 software. Results: 39,366 RCSs were performed, with a total rate for the period of 32.36 per 105 inhabitants. The annual rate of surgeries from 2008 to 2018 increased from 24.55 to 49.11 per 10 5 /year. When adjusting for year, an annual increase in surgery rates of 8.19% (95% CI 6.7–9.6) and 101% growth between 2008 and 2018 (95% CI 90–109%, p < 0.001) was observed. When comparing the global rates according to the healthcare system, the public system corresponds to 21.3 per 10 5 and the private system to 72 per 10 5 , the latter being 3.4-times higher (95% CI 2.7–4.4; p < 0.001). Conclusion: RCS rates are increasing in Chile concordantly with previous reports of other western countries. The most important factor associated with RCS rate found was the patients’ healthcare system, with higher rates observed for the private sector.