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Value- driven Pediatric Trigger Thumb Surgery: Utilizing a Minimal Operating Room Set-Up
Francine Zeng, MD
1, Lisa Tamburini, MD
1, Bhavana Ghunda, BS
1, Adam Weaver, PT, DPT
2; Sonia Chaudhry, MD
3(1)University of Connecticut, Farmington, CT, (2)Connecticut Children's Medical Center, Hartford, CT, (3)Connecticut Children's Medical Center, Hartford, CT
Introduction: Operating rooms account for approximately 70% of hospital waste and generate significant costs to the medical system. We hypothesize that pediatric trigger thumb surgery can be safely performed with a minimal operating room set-up to promote value-based care without increasing complication rates.
Material & Methods: A retrospective chart review was performed for pediatric patients undergoing A1 pulley release for trigger thumb from January 1, 2017 to December 31, 2023 at a single institution. Charts were reviewed for demographic information, surgical characteristics, surgical supply costs, number of surgical supplies, and post-operative complications (infection, wound, recurrence, other). Two groups were created based on surgical supply lists (minimal set-up vs. traditional set-up). A minimal set-up includes blue towels and basic instruments, excluding gowns, additional gloves, drapes, and dressing supplies. Costs were adjusted to November 2023 using the consumer price index for medical supplies. Patients undergoing bilateral releases or with concomitant additional procedures were excluded. Mann-Whitney U-tests were performed to compare averages.
Results: 189 patients (72 in the minimal set-up group and 117 in the traditional set-up group) were included in analysis. No differences in demographics were noted between groups. There was a significant difference in surgical cost between groups. The minimal set-up group had an average adjusted cost of $53.00 ± $16.10 and the traditional group had an average adjusted cost of $69.90 ± $21.30 (p<0.001). The traditional set-up group required an average of 2.91 additional supplies that were unopened at the beginning of the case compared to 1.85 supplies in the minimal set-up group (p=0.009). The time between cases (turnover time) was significantly less in the minimal group as well. Turnover time in the minimal group was 18.1 minutes compared to 19.5 minutes in the traditional group (p=0.035). There were no significant differences noted in complications between groups.
Conclusions: Utilizing a minimal operating room set-up for simple hand procedures, such as pediatric trigger thumb release, significantly reduces hospital costs and improved turnover time between cases. The minimal set-up does not increase patient complication rates compared to the traditional set-up. These results highlight the efficacy of incorporating changes in the operating room to reduce healthcare costs and waste, and considerations to implement this minimal set-up to additional procedures should be further studied.
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