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Cost Analysis of Endoscopic Carpal Tunnel Release with MAC Versus Local Anesthesia
Thomas J Carroll, MD
1; Akhil Dondapati, MD
2; Andrew Park, MD
2; Constantinos Ketonis, MD, PhD
11University of Rochester Medical Center, Rochester, NY; 2University of Rochester, Rochester, NY
Introduction: Endoscopic carpal tunnel release (ECTR) surgery using local anesthesia has been associated with shorter total operating room time, tourniquet time, post-operative time to discharge, and total time spent in the surgical center compared to monitored anesthesia care (MAC). We hypothesized that ECTR using local anesthesia would demonstrate significantly lower costs compared to MAC.
Materials and Methods: We retrospectively compared the surgical costs of 844 patients undergoing isolated ECTR between 2018-2024. Surgeries were performed at a surgical center associated with a large academic medical practice. Patients undergoing isolated ECTR were identified using Current Procedural Terminology (CPT) code 29848. This included 187 patients undergoing ECTR with MAC and 657 with local anesthesia. Local anesthesia for both groups comprised of 10 cc of 1:1 solution of 1% lidocaine with epinephrine and 2% Marcaine injected superficial to the transverse carpal ligament within 30 minutes of the procedure. The total hospital billed procedure cost, anesthesia cost, supply cost, and post-operative care cost was calculated for each group of patients. Total time spent at the surgical center, as well as insurance type, were also recorded. Univariate analysis was completed using T-test and Chi-square analysis. Statistical significance was set at p=0.05.
Results: ECTR using local anesthesia was associated with shorter overall time spent in the surgical center compared to MAC (148.12 minutes vs 224.41 minutes; p<0.05). Total hospital billed procedure cost was significantly lower in the local only group ($5,643 vs $9,073; p<0.05). This represented an overall cost reduction of $3,430.15 in the local group. For the local group, there was also an overall lower cost of supplies ($725 vs $811; p<0.05), anesthesia cost ($0 vs $994; p<0.05), medication cost ($10 vs $69.50; p<0.05) and operating room/recover room time cost ($4844 vs $6822; p<0.05). The insurance type distribution between the two groups was significantly different, with the local group having a higher percentage of private insurance (p<0.05).
Conclusion: Patients undergoing ECTR with local anesthesia demonstrated overall shorter time spent in the surgical center with reduced total hospital billed procedure cost, anesthesia cost, medication/supply cost, and operating room/recovery room cost. ECTR with local only anesthesia was associated with an overall cost reduction of $3,430.15 compared to MAC and local.
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