Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery

Kazmers, Nikolas H.; Presson, Angela P.; Xu, Yizhe; Howenstein, Abby; Tyser, Andrew R.

doi:10.1016/j.jhsa.2018.03.051

Cited by 90 publications

(108 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our multivariable regression analysis of patients treated in the OR, we observe that use of BB/regional or MAC anesthesia significantly reduced surgical costs by 30 and 24%, respectively, as compared with general anesthesia. Although no prior literature exists to our knowledge that is specific to DQR, these results mirror those for carpal tunnel release 14,27 and trigger digit release. 20…”

Section: Discussionsupporting

confidence: 63%

“…In another study evaluating costs associated with anesthesia services for small hand surgeries, Kamnerdnakta et al concluded that such services may not be medically indicated but account for substantial costs for low-risk patients undergoing minor hand surgeries, including DQRs. 25 Although not specific for DQR, other studies have demonstrated significant and substantial cost savings associated with performing carpal tunnel release 14,26 and trigger digit release 20 in the PR setting as opposed to the OR.…”

Section: Discussionmentioning

confidence: 99%

“…VDO costing methods have been previously described, which allow access to total direct costs for materials used for patient care, facility utilization direct costs (including sterile processing costs), and timebased cost allocations including procedure/operative time and cost of staff involved in care (nursing, surgical technicians, and medical assistants). 1,13,14,16,20,23 As the outcome measure was total direct costs, rather than payments, reimbursement for the surgeon, anesthesiologist, and facility were not included; however, time-allocated costs for the surgeon, anesthesiologist, and facility use were captured by the database. All cost categories captured by the VDO tool are further illustrated in ►Appendix A.…”

Section: Operating Room Protocolmentioning

confidence: 99%

“…Both the PR and OR incur a facility cost (OR costs are 8.4-fold greater than the PR per minute of use). 14 All reported cost data were normalized using each individual's cost divided by the average cost in the dataset, to comply with institutional guidelines prohibiting the public reporting of any financial data related to the details of nonpublically disclosed contractual agreements. Each unique combination of surgical location (PR or OR), and anesthesia type (local only, BB, MAC, and GA) was defined as a distinct group.…”

Section: Operating Room Protocolmentioning

confidence: 99%

“…This has successfully identified areas of high variability in cost, leading to improved value of care delivered 1 and identification of sources of cost variation that may be targeted to improve value. [13][14][15][16][17][18] In the current study, the VDO tool was utilized to answer our primary study question of whether the choice of surgical setting (OR vs. PR), and anesthetic type (local only, BB, MAC, or GA) affect surgical encounter costs for DQR.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Stephens

Presson

et al. 2020

J Wrist Surg

Self Cite

View full text Add to dashboard Cite

Background First extensor compartment release is a common surgical procedure that represents a financial burden to the health care system. Questions/Purposes Study questions included (1) whether surgical encounter costs differ based upon surgical setting (operating room [OR] vs. procedure room [PR]) or (2) based upon anesthesia choice (local only, Bier's block [BB], monitored anesthesia care [MAC], or general [GA]) for De Quervain release (DQR). Patients and Methods Consecutive adult patients undergoing isolated unilateral DQR at a single academic medical center were identified retrospectively by Current Procedural Terminology code (25000). Using our institution's information technology value tools, we calculated total direct costs for each surgical encounter. Costs were adjusted to January 2016 dollars using the Consumer Price Index, normalized using each participant's surgical encounter cost divided by the median cost in the PR group, then compared across each group using Kruskal–Wallis and Nemenyi's post hoc pair-wise tests. Multivariable gamma regression analysis with a log link was performed to identify factors associated with surgical costs. QuickDASH (disabilities of the arm, shoulder, and the hand) scores were compared using a t-test at final follow-up. Results Among 58 included patients, 29% (17/58) were treated in the PR and 71% (41/58) in the OR. Compared with local only in the PR, all other groups were significantly more costly. Multivariable gamma regression indicated that use of OR/BB, OR/MAC, or OR/GA independently led to 211, 222, and 357% greater surgical costs as compared with the PR with local only while controlling for provider and patient age. Furthermore, QuickDASH scores were similar between PR and OR groups at final follow-up. Conclusion Performing DQR in the PR setting under local only anesthesia yields greater value than the OR, as patient-reported outcomes are similar despite significantly lower surgical costs. Level of Evidence This is a Level III, cost analysis study.

show abstract

Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Operating Room Protocolmentioning

confidence: 99%

Section: Operating Room Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Stephens

Presson

et al. 2020

J Wrist Surg

Self Cite

View full text Add to dashboard Cite

show abstract

Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings

Billig

Nasser²,

Chen

et al. 2020

JAMA Netw Open

View full text Add to dashboard Cite

IMPORTANCE Surgical procedures can be performed in different settings, but the association between the operative setting and patient safety and cost to the patient and payer is unknown. OBJECTIVE To examine differences in complications, total payments, and out-of-pocket (OOP) spending for minor hand surgical procedures performed in office, ambulatory surgery center (ASC), and hospital outpatient department (HOPD) operative settings. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cohort study was conducted using deidentified claims data from private employer-sponsored health insurance from January 1, 2009, to December 31, 2017. Patients aged 18 years or older undergoing carpal tunnel release, trigger finger release, excision of wrist ganglion, and excision of small hand masses (N = 468 365) were included. EXPOSURES Operative setting, defined as procedures performed in the clinic setting, ASC, and HOPD. MAIN OUTCOMES AND MEASURES Complications during the 90-day postoperative period, total payments (total facility and payer reimbursement), and OOP spending.

show abstract

Grundzüge der operativen Behandlung

Assmus

2023

Nervenkompressionssyndrome

View full text Add to dashboard Cite

Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery

Abstract: This study identifies modifiable factors that may lead to cost reductions for CTR surgery.

Cited by 90 publications

References 20 publications

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings

Grundzüge der operativen Behandlung

Contact Info

Product

Resources

About