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Introduction The volume and type of hand surgery procedures for a practicing hand surgeon determine the utilization cost of a tourniquet system. A survey of six hand surgeons from orthopedic and plastic surgery shows that some simple hand surgeries may be performed safely using an elastic tourniquet created from an esmarch bandage, such as removal of benign lesions, trigger finger and carpal tunnel release. There is no surgeon perceived differences in the creation of a bloodless surgical field or blood loss while using an elastic tourniquet in these cases. Whereas more extensive upper extremity procedures require a pneumatic tourniquet and thus necessitating the availability of a tourniquet machine and suitable cuffs.

Methods Based on the expenses at our institution, models are designed to demonstrate the cost effectiveness of purchasing a pneumatic tourniquet system based upon the number of surgeries performed per year.

Results The average variable cost (AVC) of a sterile pneumatic cuff is equal to the retail price (mean = $24.62, ranging = $19.90 - 30.40 for size 12 to 42-inch cuffs). With a fixed cost of $4,000 for a tourniquet machine, the average fixed cost (AFC) starts at $2.50 and approaches $0.33 per case as the volume of cases increase. The average total cost (ATC) takes in to account both the AVC and AFC and decreases from $32.62 to $24.95 per case with a growing practice. If recycled cuffs are available, the discounted ATC drops down to $10.27. In comparison, for surgeries that do not rely on a pneumatic tourniquet system, there is no associated fixed cost. Therefore, AVC and ATC are the same and is stagnant at the fix price of $4.35. Consequently, there is a cost saving in equipment of up to $28.27 when an elastic as opposed to a pneumatic tourniquet is indicated in hand surgery. Additionally, there is a small yet non-neglectable labor cost for the extra time of 12 to 15 seconds in the application and setup of the pneumatic tourniquet during surgery.

Conclusions Our investment cost modeling shows that hand surgeons benefit most financially from using an elastic tourniquet when appropriate and the ATC decreases with increasing productivity when pneumatic tourniquet system is involved.