Back to 2026 ePosters
More Than Worth It: The Economic Case for Shifting Minor Hand Surgeries to the Procedure Room
Thompson Zhuang, MD MBA
1, George R Nageeb, BS
2, Lauren M Shapiro, MD, MS
3; Robin N Kamal, MD, MBA, MS
4(1)University of Pennsylvania, Philadelphia, PA, (2)Stanford University, Stanford, CA, (3)University of California, San Francisco, San Francisco, CA, (4)Stanford University, Redwood City, CA
Introduction: While minor hand surgeries are increasingly performed in the procedure room (PR) setting, there is a lack of population-level comparative cost analyses of minor hand procedures performed in the PR versus operating room (OR) settings. This data can inform accountable care efforts to optimize PR use and reduce costs. In this study, we conducted a population-level comparative cost analysis of minor hand surgeries performed in the PR versus OR settings.
Methods: Using the MarketScan databases, we identified adult patients undergoing minor hand surgery, defined as open or endoscopic carpal tunnel release, trigger finger release, DeQuervain release, ganglion cyst excision, or hand mass excision, from 2007-2022. Procedure setting was classified as PR or OR. OR procedures were further subdivided by the presence or absence of anesthesia codes. Costs were defined as reimbursements, separated into professional and facility fees. All costs from the day of surgery as well as within 90 days of surgery (non-inclusive of surgery date) were summarized. Cost savings between PR and OR settings were estimated as the difference in mean day-of-surgery costs. We modeled trends in the proportion of procedures performed in the PR setting during the study period using linear regression models.
Results: The distribution of costs from minor hand surgery is shown in Table 1. While surgeon fees were higher in the PR setting, these were eclipsed by a substantial reduction in the total day-of-surgery cost for the PR compared to the OR setting (with or without anesthesia), which was driven by the elimination of the facility fee. The mean estimated per-case cost savings from shifting procedures to the PR setting varied by procedure (Figure 1). The largest estimated per-case cost savings was observed with carpal tunnel release, which was associated with over $2,000 in savings per case when performed in the PR as opposed to the OR with or without anesthesia. From 2007-2022, the proportion of minor hand surgeries performed in the PR setting increased, with the largest annual rates of increase seen for trigger finger release and ganglion cyst excision (Table 2, Figure 2).
Conclusions: Shifting minor hand surgeries from the OR to the PR setting was associated with significant cost savings. While PR utilization generally increased from 2007-2022, differences in the rate of increase existed by procedure. A large opportunity exists to further understand how to shift more of these procedures to the PR setting, especially carpal tunnel release.
Back to 2026 ePosters
