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American Association for Hand Surgery

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Cost Drivers in Carpal Tunnel Release Surgery: An Analysis of 8717 patients in New York State
Peter G Brodeur, MA1, Jeremy E Raducha, MD1, Devan D Patel, MD1, Aristides I Cruz, Jr., MD, MBA1 and Joseph A Gil, MD2, (1)Alpert Medical School of Brown University, Providence, RI, (2)Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI

Introduction:
Carpal tunnel syndrome (CTS) is the most common upper extremity neuropathy and the high number for carpal tunnel releases (CTR) annually has a large financial impact on the healthcare system. Identifying the cost drivers related to CTR in a large, diverse patient population will help demonstrate where money can be saved to decrease overall costs.
Materials & Methods:
Adult patients with CTS, who underwent CTR were identified in the New York Statewide Planning and Research Cooperative System database from 2016-2017. A multivariable mixed model regression with random effects for the facility was performed to assess the variables that contribute significantly to the total charge of the claim. The variables included in the regression were patient age, gender, anesthesia method, whether the surgery took place in an ambulatory surgery center (ASC) vs. a hospital outpatient department (HOPD), operation time in minutes, primary insurance type, race, ethnicity, Charlson Comorbidity Index (CCI), and categories for billed procedure codes.
Results:
8,717 claims were included from 2016-2017 with a mean charge per claim of $4,865, ranging from $2,378-$8,606. General anesthesia was associated with higher charges when compared to local anesthesia. Having the procedure in a HOPD was associated with approximately a 48.2% increase in total charge amount when compared to ASC. A one-minute increase in operation time was associated with a 0.3% increase in total charge. Claims with an EKG, anti-emetics, anti-histamines, benzodiazepines, IV fluids, narcotic agents, steroids, or preoperative antibiotics were associated with higher total charge amounts with respect to claims that did not bill for these agents. Compared to endoscopic procedures, open procedures had a 44.3% decrease in charges.
Conclusions:
General anesthesia, hospital-based surgery, the use of antibiotics and opioids, longer operative times and endoscopic carpal tunnel release all significantly increased the costs of surgery. The use of local only anesthesia, performing surgeries in an ambulatory or office setting and eliminating the use of unnecessary medications may help reduce overall procedure related costs.



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