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Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery.
- Source :
-
The Journal of hand surgery [J Hand Surg Am] 2018 Nov; Vol. 43 (11), pp. 971-977.e1. Date of Electronic Publication: 2018 May 18. - Publication Year :
- 2018
-
Abstract
- Purpose: Carpal tunnel release (CTR) is a common surgical procedure, representing a financial burden to the health care system. The purpose of this study was to test whether the choice of CTR technique (open carpal tunnel release [OCTR] vs endoscopic carpal tunnel release [ECTR]), surgical setting (operating room vs procedure room [PR]), and anesthetic type (local, monitored anesthesia care [MAC], Bier block, general) affected costs or payments.<br />Methods: Consecutive adult patients undergoing isolated unilateral CTR between July 2014, and October 2017, at a single academic medical center were identified. Patients undergoing ECTR converted to OCTR, revision surgery, or additional procedures were excluded. Using our institution's information technology value tools, we calculated total direct costs (TDCs), total combined payment (TCP), hospital payment, surgeon payment, and anesthesia payment for each surgical encounter. Cost data were normalized using each participant's surgical encounter cost divided by the average cost in the data set and compared across 8 groups (defined by surgery type, operation location, and anesthesia type).<br />Results: Of 479 included patients, the mean age was 55.3 ± 16.1 years, and 68% were female. Payer mix included commercial (45%), Medicare (37%), Medicaid (13%), workers' compensation (2%), self-pay (1%), and other (3%) insurance types. The TDC and TCP both differed significantly between each CTR group, and OCTR in the PR under local anesthesia was the lowest. The OCTR/local/operating room, OCTR/MAC/operating room, and ECTR/operating room, were associated with 6.3-fold, 11.0-fold, and 12.4-16.6-fold greater TDC than OCTR/local/PR, respectively.<br />Conclusions: Performing OCTR under local anesthetic in the PR setting significantly minimizes direct surgical encounter costs relative to other surgical methods (ECTR), anesthetic methods (Bier block, MAC, general), and surgical settings (operating room).<br />Clinical Relevance: This study identifies modifiable factors that may lead to cost reductions for CTR surgery.<br /> (Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Ambulatory Surgical Procedures economics
Anesthesia, General economics
Anesthetics, Local economics
Anesthetics, Local therapeutic use
Costs and Cost Analysis
Decompression, Surgical methods
Endoscopy economics
Female
Humans
Male
Middle Aged
Nerve Block economics
Operating Rooms economics
Retrospective Studies
United States
Carpal Tunnel Syndrome economics
Carpal Tunnel Syndrome surgery
Decompression, Surgical economics
Subjects
Details
- Language :
- English
- ISSN :
- 1531-6564
- Volume :
- 43
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- The Journal of hand surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29784549
- Full Text :
- https://doi.org/10.1016/j.jhsa.2018.03.051