Metacarpal Fracture Fixation in a Minor Surgery Setting Versus Main Operating Room: A Cost-minimization Analysis

Abstract

Background: The objective of this study was to compare the costs of performing metacarpal fracture fixation in minor surgery (MS) versus the main operating room (OR) at a tertiary care center in Calgary, Alberta, from the institutional perspective. Methods: Data were extracted from the Operating Room Information System and the Business Advisory System by a financial analyst. All data were based on actual expenses from the 2016–2017 fiscal year (US$). Direct costs included: staffing, supply, day (outpatient) surgery unit, post-anesthesia care unit (PACU), and anesthesia (anesthesiologist and equipment) costs. Surgeon and hardware costs were deemed neutral and excluded from the analysis. Results: The total cost of metacarpal fixation in MS was $250, compared to $2,226 in the OR, after surgeon and hardware costs were excluded. Staffing costs are a major contributing factor to cost by location ($75 in MS versus $233 in OR), largely attributable to 0.5 nursing staff per room in MS compared to 3 nursing staff per room in the OR. Supply costs (minor tray, $94 versus case cart, $247) are also greater for OR cases. The combined costs for DSU ($465), PACU ($435), and anesthesia ($247) totaled $1,147 and are only incurred for OR cases. Conclusions: Repair of metacarpal fractures in MS represents a substantial cost-minimization strategy from the institutional perspective. Staffing and supply costs by location and the additional combined costs of DS, PACU, and anesthesia are all contributing factors.

Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity

“…Elimination of sedation in WALANT surgery permits moving K-wire fixation procedures out of the main operating room, thereby decreasing cost (Gillis and Williams, 2017;Steve et al, 2019) and increasing surgery availability (Behar et al, 2019;Holoyda et al, 2020) without raising risk of infection using minor procedure room field sterility (Figure 2) (Avoricani et al, 2021;Dua et al, 2019;Garon et al, 2018;Jagodzinski et al, 2017;Kurtzman et al, 2021;Starker and Eaton, 1995;Yu et al, 2019).…”

“…lot of hand surgery out of the main operating room and into minor procedure rooms (Behar et al, 2019;Holoyda et al, 2020;Steve et al, 2019).…”

Low Infection Rate for Hand Fractures Managed with Surgical Fixation under Wide-Awake Local Anesthesia with No Tourniquet in Minor Surgery

“…Benefits include decreased wait times, eliminating the need for general anesthesia, and decreased medical waste. 4,7 The fixation of hand fractures in minor surgery is also more cost-effective than repair in the main operating room. 4,8 At our institution, the majority of hand fractures requiring surgical fixation are repaired in minor surgery using WALANT, with only the more complicated fractures (with concomitant nerve, vascular, or multisystem injuries) undergoing repair in the main operating room.…”

“…4,7 The fixation of hand fractures in minor surgery is also more cost-effective than repair in the main operating room. 4,8 At our institution, the majority of hand fractures requiring surgical fixation are repaired in minor Background: The purpose of this study was to review the rate and type of infectious complications after surgical fixation of hand fractures managed under wide-awake local anesthesia with no tourniquet (WALANT) in minor procedure rooms outside the main operating room. Plastic and Reconstructive Surgery • October 2022 surgery using WALANT, with only the more complicated fractures (with concomitant nerve, vascular, or multisystem injuries) undergoing repair in the main operating room.…”

Comparing the Efficacy and Safety of Metacarpal Neck Fracture Treatments: A Systematic Review and Network Meta-Analysis

“…Metacarpal fractures comprise approximately 42% of all hand fractures, estimating to cost over $2,000/hand fracture in Canada. 1 , 2 Most metacarpal fractures are isolated injuries and patients may perform well without operative intervention, but the current literature on this topic is underwhelming and guidance on managing these injuries needs further refinement.…”