Carpal Tunnel Release Performed Under Local Anesthesia in the United States: Trends in Operative Setting and Reimbursement
Alexander J Kammien, BS; Samuel Kim, MD; Adnan Prsic, MD; Jonathan N Grauer, MD; Colen L David, MD
Yale University School of Medicine, New Haven, CT
PURPOSE Office-based hand surgery has become increasingly popular with the development of wide awake, local only, no tourniquet (WALANT) techniques and has the potential for greater efficiency and reduced costs compared to surgery in the operating room (OR). The current study aimed to compare trends in volume, reimbursement and adverse events following open carpal tunnel release performed in the OR and the office.
METHODS Insurance claims data from 2010-2020Q3 were analyzed in PearlDiver. Patients who underwent open carpal tunnel release were identified using CPT-64721. Exclusion criteria were concomitant hand surgery, general anesthesia, age <18 years and <30 days of postoperative database activity. The open carpal tunnel cohort was grouped by surgical setting (OR or office), and the annual number of surgeries in each location was determined. The two groups were then matched 4:1 by age, sex, and Elixhauser Comorbidity Index. Total and physician reimbursement for the surgery, as well as thirty-day rates of narcotic use, emergency department visits and surgical site infections were extracted. Reimbursement and adverse events were compared using T-tests and chi-squared tests.
RESULTS The final cohort consisted of 309,204 patients who underwent WALANT open carpal tunnel release: 303,741 (98%) in the OR and 5,463 (2%) in the office. From 2010 to 2020, the percent of surgeries taking place in the office nearly tripled (1.2% to 3.4%). Matching established an OR cohort of 21,846 patients and an office cohort of 5,462. Mean (stdev) total reimbursement in the OR was (1,445) compared to (1,098) in the office (p<0.001). Physician reimbursement was (612) in the OR and (450) in the office (p<0.001). The OR cohort filled more narcotics prescriptions in the thirty-day postoperative period compared to the office cohort (58% vs 46%, p<0.001). The cohorts had similar rates of emergency department visits (4% in the OR, 3% in the office, p=0.301) and surgical site infections (<1% for both, p=0.718).
CONCLUSIONS Office-based surgeries are time-efficient and have high patient satisfaction. The current study indicates that office surgeries are becoming increasingly popular, have a lower financial burden on the healthcare system, only small differences in physician reimbursement and similar rates of adverse events compared to OR-based surgeries. Hand surgeons, therefore, have great incentive to perform operations in the office rather than the OR when possible.
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