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Cost and Efficiency Analysis of Percutaneous Fixation of Hand Fractures in the Main Operating Room Versus the Ambulatory Setting in Canada
Joshua A. Gillis, MD, BSc; Jason Williams, MD, MEd
Dalhousie University, Halifax, NS, Canada

Background: Hand fractures are the second most common fractures and are a significant cause of morbidity. Definitive treatment of reducible but unstable fractures may involve closed reduction internal fixation (CRIF). To date, there have been no studies identifying the cost differential for performing CRIF of hand fractures in the operating room (OR) versus an outpatient clinic setting under field sterility. Our goal was to analyze the cost and efficiency of performing CRIF in these two settings and to document current practice trends in Canada.
Methods: A detailed cost analysis of the salaries of personnel involved both directly and indirectly in the CRIF of a hand fracture, including the material and hospital fees, was conducted using available fee codes and wages. Hospital statistical records were used to calculate efficiency, including average operative and turnover time. A survey was distributed to practicing plastic surgeons across Canada regarding their current practice of managing hand fractures.
Results: The average wait time at our institution for hand fracture CRIF in the OR is 3 days versus 0 days in an ambulatory care setting. According to institutional averages, it takes 90 minutes to perform a hand fracture CRIF in the OR, including set-up and cleanup. There is an average 25-minute turnover time between cases. Thus, in an 8-hour surgical block, we are able to perform approximately five K-wire fixations in the OR. In an outpatient setting, we are able to perform approximately eight cases in the same 8-hour block. The costs of performing a K-wire fixation of a hand fracture in the main OR under local anaesthetic is .77 CDN compared to .42 CDN in the ambulatory setting. The use of a regional block increases the cost to .24 CDN.
The final results of the online survey are pending.
Conclusion: The use of the main OR for K-wire fixation of hand fractures under a regional block or general anesthetic leads to a significant increase in cost and hospital resources compared to the use of an outpatient ambulatory setting under local anaesthetic. This doesn’t take into account patient travel costs, or costs for anaesthetic drugs. There is decreased efficiency when performing CRIF in the OR, with longer turn around time, and many more health professionals involved in the peri-operative care. We conclude that for appropriately selected hand fractures, CRIF in a clinic setting is more cost effective and efficient compared to the main OR.

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