Beach-Chair versus Lateral Decubitus Positioning: A Comparison of Set-Up Time and Cost for Arthroscopic Rotator Cuff Repair

Author(s): Matthew T. Glazier, DO, Hayden B. Schuette DO, Brian D. Sullivan, DO, Stephen P. Wiseman, DO, Nathaniel K. Long, DO

Introduction: Patients can be positioned in either the beach-chair or lateral decubitus position when undergoing arthroscopic rotator cuff repair. Authors have argued the advantages and disadvantages of both positions. The primary purpose of this retrospective review is to compare the time for set-up, identify differences in cost, and secondarily report on any complications experienced depending on patient positioning during arthroscopic rotator cuff repair.

Materials and Methods: This single-institution retrospective review included two hundred and ninety-six patients who underwent arthroscopic shoulder surgery between January 2018 and January 2019. Two groups were established, one for patients in the beach-chair position and another for those in the lateral decubitus position. Primary outcomes collected included time from intubation to incision, time from closure to extubation, total procedure time, supply costs, implant costs, and total supply costs. Secondary outcomes collected included minor and major complications and the number of staff used during the procedure.

Results: One hundred and fifty-nine patients were in the beach-chair group, and 137 were in the lateral decubitus group. There were no statistical differences in demographics. The lateral decubitus positioning group had a significantly shorter time from intubation to incision (29.3 min vs. 37.4 min, P <0.001), lower total operative time (60.6 min vs. 85.6 min, P < 0.001), required less staff (7.0 vs. 7.5, P < 0.001), and decreased isolated supply costs ($238 vs. $415, P < 0.001). There was no significant difference in time from closure to extubation between the beach-chair and lateral positions (16.6 min vs. 16.4 min, P=0.838). Total implant cost was higher in the beach-chair group than in the lateral decubitus group ($1,502 vs. $1,152, P=0.053), although this difference did not reach statistical significance. There were no significant complications requiring further surgical intervention. All minor complications were resolved with conservative measures by final follow-up with no statistically significant difference between the two groups (1.9% vs. 5.1%, P=0.196).

Conclusions: The results of our study demonstrate that arthroscopic rotator cuff repair in the lateral decubitus position requires decreased time for set up and has decreased supply costs. Strategies should be implemented to improve efficiency, reduce overall operative time, and lower supply costs. Ultimately, the decision on arthroscopic shoulder positioning should be based on surgeon comfort and training for optimal patient outcomes.

Level of Evidence: Level III: Retrospective comparative study