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Intraoperative Cost Comparison of Endoscopic Carpal Tunnel Release with WALANT versus MAC Anesthesia
Jenna Godfrey, MD
Slocum Center for Sports Medicine and Orthopedics, Eugene, OR
Purpose: The purpose of this study was to utilize previously published capacity cost rates for endoscopic carpal tunnel release (ECTR) performed in an academic setting in combination with our institutional intraoperative process map to approximate the total cost of (ECTR) performed in an Ambulatory Surgical Care (ASC) setting. Further, we analyzed two anesthetic techniques; wide-awake, local anesthesia, no tourniquet (WALANT) versus monitored anesthetic care (MAC). We report complication rates over a three-year period for patients included in the study.
Methods: This study includes 481 ECTR under WALANT and 405 ECTR under MAC, performed between January 2019 and December 2021 in a private practice ASC. Utilizing previously reported direct operating room costs, overhead, and material costs we calculated a final cost for each procedure. We also report our complication rates: intraoperative conversion to open carpal tunnel release (OCTR) and late revision to OCTR.
Results: Intraoperative times were shortest for ECTR performed under WALANT (22 minutes), versus ECTR under MAC (25 minutes). Total cost for ECTR under WALANT was most cost effective at $1341.28 versus ECTR under MAC at $1634.00. Five patients underwent late revision to OCTR during the study period (0.56%); 11 patients were converted to OCTR intraoperatively (1.1%).
Conclusions: Our intraoperative process flow, staffing model, and ASC setting, realized a 48.4% cost savings for ECTR under WALANT when compared to previously reported costs in an academic setting. This concept paper identified meaningful costs savings based on technique, location of service, operating room time, and personnel, as well as reporting a less than 1% late complication rate.
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