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A Direct Cost Comparison Study of Open Carpal Tunnel Surgery
Brad T. Morrow, MD; Logan Carr, MD; William B. Albright, MD; Brett Michelotti, MD; Randy Hauck, MD
Penn State Hershey Medical Center, Hershey, PA

Background: Wide-awake hand surgery under local anesthesia has led many surgeons to move from the operating room (OR) or outpatient surgery center (OSC) to the clinic. With the cost of healthcare rising, procedures must be performed in the most cost-effective venue with the lowest cost to maximize profits.

Objective: We performed a direct costs analysis of a single surgeon performing an open carpal tunnel release as an isolated procedure in the OR, OSC and clinic.

Methods: Four treatment groups were prospectively studied; OR with monitored anesthesia care, OSC with MAC, OSC with local anesthesia and the clinic with local anesthesia. To determine direct costs, a detailed inventory of all supplies and the price per unit was recorded including the weight and disposal of medical waste. Indirect costs such as support-staff salaries and equipment depreciation were not included as a quantitative number could not be objectively assigned.

Results: Five cases in each treatment group were prospectively recorded. Average direct costs were OR (\.55), OSC-MAC (\.12), OSC-local (\.16) and clinic (\.09). The surgical waste per case was collected and the average weight was the OR (4.78kg), OSC-MAC (2.78kg), OSC-local (2.6kg) and the clinic (0.65kg). Using ANOVA, there was a statistically significant decrease in the direct costs and medical waste in the clinic versus every other setting (p<0.005).

Conclusions: The direct costs of an open CTR with local anesthesia were two times more expensive in the OSC compared to the clinic. Increased costs were the result of full sterility which is reflected by a five-fold increase in medical waste. Conversely, in the clinic, field sterility with re-usable towels is utilized. The direct costs in the OR were seven times more expensive than the clinic. Increased costs were due to full sterility with an eight-fold increase in medical waste. Increased costs were incurred as all patients in the OR received MAC while all patients in the clinic were satisfactorily managed with local anesthesia. Anesthetic agents were included in the direct costs analysis but the anesthesiologist's professional fee was not included which would significantly increase the overall cost. A limitation is the exclusion of indirect costs, however, one can argue that indirect costs are more substantial in the OR and OSC than the clinic and thus the overall cost would be increased and the profit margin decreased. Open carpal tunnel release is more cost-effective and generates less medical waste when performed in the clinic.

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