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

Abstract

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.

Comparison of Complication Risk for Open Carpal Tunnel Release: In-office versus Operating Room Settings

“…Rates of pooled major medical complications were low and similar following oCTR performed in either setting, as were pooled surgical site/wound complications and iatrogenic complications. In light of these findings supporting a similar safety profile, prior studies illustrating a substantial cost reduction associated with use of the PR setting for oCTR when compared with the OR, [3][4][5][6][7][8][9][10][11][12][13] and similar clinical outcomes following oCTR performed in PR and OR settings, 33 we conclude that the value of utilizing the PR setting for oCTR is greater than that of the OR.…”

“…Substantial literature within the field of hand surgery has suggested that one effective method of surgical cost reduction is the utilization of a procedure room setting (PR), rather than the operating room setting (OR) for minor procedures. [3][4][5][6][7][8][9][10][11][12][13] Compared with the more traditional OR surgical setting with full sterility utilizing regional or general anesthesia, office-based PR surgical settings for minor hand procedures use field sterility under pure local anesthesia with lidocaine and epinephrine. Generally, a tourniquet is not used in the PR setting.…”

“…Open carpal tunnel releases (oCTR), trigger finger release, de Quervain release, and other minor procedures are feasible using WALANT techniques (wideawake, local-only anesthesia, no tourniquet) in the PR setting, which has been proposed to improve the value of care for patients. [3][4][5][6]8,9,11,12,[14][15][16] Specific to oCTR, direct costs may range from four-fold 9 to 30-fold 3 greater for the OR, when compared with the PR. In addition to utilizing the WALANT technique, decreased medical consultation and testing with utilization of the PR setting may further lead to lower preoperative and overall costs.…”

Evaluation of factors driving cost variation for distal humerus open reduction internal fixation

“…Although the actual raw data of cost could not be disclosed because of contractual agreements at our institution, the impact of certain variables on cost can still be evaluated as a relative increase from a baseline value and has been used in other studies. 7 , 20 , 22 , 42 , 44 Lastly, this study was not designed as a cost-effectiveness analysis as we only evaluated surgical direct costs. Therefore, postoperative costs including those related to complications or time off of work were not considered, and the health state of each patient over time was not assessed.…”