With rising costs in the US healthcare system, a great deal of interest has developed in the application of value-based principles to healthcare. Value can be defined as a gain in benefits over the costs expended.14 The average cost for a commercial CC unit used in this study was $260. A pack of ICE is a nominal cost. Based on the results of this study, the cost of the commercial CC device may not be justified when compared to the cost of an ice pack.
The major strengths of this study are the randomized design and multiple data points during the early postoperative period. However, there are several limitations. First, we did not objectively measure compliance of either therapy and relied only on a patient survey. Usage of the commercial CC unit in hours decreased over half between days 3 and 14. This occurred despite training on the application and specific instructions. We believe this reflects “real-world” usage, but it is possible that compliance affected our results. Second, all patients in this study had a single-shot interscalene block. While this is standard at our institution, it is possible that either CC or ICE would have a more significant effect in the absence of an interscalene block. Finally, we did not evaluate final outcomes in this study and therefore cannot determine if the final outcome was different between the 2 groups. Our goal was simply to evaluate the first 2 weeks following surgery, as this is the most painful period following TSA.
CONCLUSION
There was no difference between CC and ICE in terms of pain control, quality of sleep, patient satisfaction, or narcotic consumption following TSA. CC may offer convenience advantages, but the increased cost associated with this type of unit may not be justified.