PDF herunterladen
J Wrist Surg 2020; 09(04): 289-297
DOI: 10.1055/s-0040-1708863
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Andrew R. Stephens
1   School of Medicine, University of Utah, Salt Lake City, Utah
2   Department of Orthopaedics, University of Utah, Salt Lake City, Utah
,
Ziji Yu
3   Division of Public Health, University of Utah, Salt Lake City, Utah
,
Angela P. Presson
2   Department of Orthopaedics, University of Utah, Salt Lake City, Utah
3   Division of Public Health, University of Utah, Salt Lake City, Utah
4   Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, Utah
,
Andrew R. Tyser
1   School of Medicine, University of Utah, Salt Lake City, Utah
2   Department of Orthopaedics, University of Utah, Salt Lake City, Utah
,
Nikolas H. Kazmers
1   School of Medicine, University of Utah, Salt Lake City, Utah
2   Department of Orthopaedics, University of Utah, Salt Lake City, Utah
› Institutsangaben Funding A.P. received funding from the NIH in the form of a grant, this investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-02 (formerly 8UL1TR000105 and UL1RR025764).
Weitere Informationen

Publikationsverlauf

22. Juli 2019

13. Februar 2020

Publikationsdatum:
17. April 2020 (online)

    Lizenzen und Reprints

Abstract

Background First extensor compartment release is a common surgical procedure that represents a financial burden to the health care system.

Questions/Purposes Study questions included (1) whether surgical encounter costs differ based upon surgical setting (operating room [OR] vs. procedure room [PR]) or (2) based upon anesthesia choice (local only, Bier's block [BB], monitored anesthesia care [MAC], or general [GA]) for De Quervain release (DQR).

Patients and Methods Consecutive adult patients undergoing isolated unilateral DQR at a single academic medical center were identified retrospectively by Current Procedural Terminology code (25000). Using our institution's information technology value tools, we calculated total direct costs for each surgical encounter. Costs were adjusted to January 2016 dollars using the Consumer Price Index, normalized using each participant's surgical encounter cost divided by the median cost in the PR group, then compared across each group using Kruskal–Wallis and Nemenyi's post hoc pair-wise tests. Multivariable gamma regression analysis with a log link was performed to identify factors associated with surgical costs. QuickDASH (disabilities of the arm, shoulder, and the hand) scores were compared using a t-test at final follow-up.

Results Among 58 included patients, 29% (17/58) were treated in the PR and 71% (41/58) in the OR. Compared with local only in the PR, all other groups were significantly more costly. Multivariable gamma regression indicated that use of OR/BB, OR/MAC, or OR/GA independently led to 211, 222, and 357% greater surgical costs as compared with the PR with local only while controlling for provider and patient age. Furthermore, QuickDASH scores were similar between PR and OR groups at final follow-up.

Conclusion Performing DQR in the PR setting under local only anesthesia yields greater value than the OR, as patient-reported outcomes are similar despite significantly lower surgical costs. Level of Evidence This is a Level III, cost analysis study.

Keywords

cost - De Quervain - surgery/surgical - tendinitis - tendinopathy - value

Ethical Approval

This study was approved by our institution's IRB.


 

  • References

  • 1 Lee VS, Kawamoto K, Hess R. , et al. Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. JAMA 2016; 316 (10) 1061-1072
    CrossrefPubMedSuche in Google Scholar
  • 2 Kawamoto K, Martin CJ, Williams K. , et al. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes. J Am Med Inform Assoc 2015; 22 (01) 223-235
    CrossrefPubMedSuche in Google Scholar
  • 3 Ippolito JA, Hauser S, Patel J, Vosbikian M, Ahmed I. Nonsurgical treatment of De Quervain tenosynovitis: a prospective randomized trial. Hand (N Y) 2018; (e-pub ahead of print); doi:10.1177/ 1558944718791187
    PubMedSuche in Google Scholar
  • 4 Richie III CA, Briner Jr WW. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract 2003; 16 (02) 102-106
    CrossrefPubMedSuche in Google Scholar
  • 5 Oh JK, Messing S, Hyrien O, Hammert WC. Effectiveness of corticosteroid injections for treatment of de Quervain's tenosynovitis. Hand (N Y) 2017; 12 (04) 357-361
    CrossrefPubMedSuche in Google Scholar
  • 6 Lee HJ, Kim PT, Aminata IW, Hong HP, Yoon JP, Jeon IH. Surgical release of the first extensor compartment for refractory de Quervain's tenosynovitis: surgical findings and functional evaluation using DASH scores. Clin Orthop Surg 2014; 6 (04) 405-409
    CrossrefPubMedSuche in Google Scholar
  • 7 Mangukiya HJ, Kale A, Mahajan NP, Ramteke U, Manna J. Functional outcome of De Quervain's tenosynovitis with longitudinal incision in surgically treated patients. Musculoskelet Surg 2019; 103 (03) 269-273
    CrossrefPubMedSuche in Google Scholar
  • 8 Ta KT, Eidelman D, Thomson JG. Patient satisfaction and outcomes of surgery for de Quervain's tenosynovitis. J Hand Surg Am 1999; 24 (05) 1071-1077
    CrossrefPubMedSuche in Google Scholar
  • 9 Scheller A, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop 2009; 33 (05) 1301-1303
    CrossrefPubMedSuche in Google Scholar
  • 10 Kang HJ, Hahn SB, Kim SH, Choi YR. Does endoscopic release of the first extensor compartment have benefits over open release in de Quervain's disease?. J Plast Reconstr Aesthet Surg 2011; 64 (10) 1306-1311
    CrossrefPubMedSuche in Google Scholar
  • 11 Rhee PC, Fischer MM, Rhee LS, McMillan H, Johnson AE. Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures. J Hand Surg Am 2017; 42 (03) e139 –e147
    CrossrefPubMedSuche in Google Scholar
  • 12 Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005; 30 (05) 1061-1067
    CrossrefPubMedSuche in Google Scholar
  • 13 Kazmers NH, Judson CH, Presson AP, Xu Y, Tyser AR. Evaluation of factors driving cost variation for distal radius fracture open reduction internal fixation. J Hand Surg Am 2018; 43 (07) 606-614.e1
    CrossrefPubMedSuche in Google Scholar
  • 14 Kazmers NH, Presson AP, Xu Y, Howenstein A, Tyser AR. Cost implications of varying the surgical technique, surgical setting, and anesthesia type for carpal tunnel release surgery. J Hand Surg Am 2018; 43 (11) 971-977.e1
    CrossrefPubMedSuche in Google Scholar
  • 15 Kazmers NH, Stephens AR, Presson AP, Xu Y, Feller RJ, Tyser AR. Comparison of direct surgical costs for proximal row carpectomy and four-corner arthrodesis. J Wrist Surg 2019; 8 (01) 66-71
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Chalmers PN, Granger E, Nelson R, Yoo M, Tashjian RZ. Factors affecting cost, outcomes, and tendon healing after arthroscopic rotator cuff repair. Arthroscopy 2018; 34 (05) 1393-1400
    CrossrefPubMedSuche in Google Scholar
  • 17 Chalmers PN, Kahn T, Broschinsky K. , et al. An analysis of costs associated with shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28 (07) 1334-1340
    CrossrefPubMedSuche in Google Scholar
  • 18 Karns MR, Jones DL, Todd DC. , et al. Patient- and procedure-specific variables driving total direct costs of outpatient anterior cruciate ligament reconstruction. Orthop J Sports Med 2018; 6 (08) 2325967118788543
    Suche in Google Scholar
  • 19 Wolfe SW. Tedinopathy. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. Green's Operative Hand Surgery. 7th ed. Elsevier; 2016
    Suche in Google Scholar
  • 20 Kazmers NH, Stephens AR, Presson AP, Yu Z, Tyser AR. Cost implications of varying the surgical setting and anesthesia type for trigger finger release surgery. Plast Reconstr Surg Glob Open 2019; 7 (05) e2231
    CrossrefPubMedSuche in Google Scholar
  • 21 Lalonde DH, Wong A. Dosage of local anesthesia in wide awake hand surgery. J Hand Surg Am 2013; 38 (10) 2025-2028
    CrossrefPubMedSuche in Google Scholar
  • 22 Zhang JX, Gray J, Lalonde DH, Carr N. Digital necrosis after lidocaine and epinephrine injection in the flexor tendon sheath without phentolamine rescue. J Hand Surg Am 2017; 42 (02) e119-e123
    CrossrefPubMedSuche in Google Scholar
  • 23 Kazmers N, Lazaris EL, Allen CM, Presson AP, Tyser AR. Comparison of surgical encounter direct costs for three methods of cubital tunnel decompression. Plast Reconstr Surg 2019; 143 (02) 503-510
    CrossrefPubMedSuche in Google Scholar
  • 24 Pohlert T. . PMCMR: Calculate Pairwise Multiple Comparisons of Mean Rank Sums. Available at: http://CRAN.R-project.org/package=PMCMR . Accessed July 1, 2017
    PubMed
  • 25 Kamnerdnakta S, Huetteman HE, Chung KC. Use and associated spending for anesthesiologist-administered services in minor hand surgery. Plast Reconstr Surg 2018; 141 (04) 960-969
    CrossrefPubMedSuche in Google Scholar
  • 26 Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada. Hand (N Y) 2007; 2 (04) 173-178
    CrossrefPubMedSuche in Google Scholar
  • 27 Foster BD, Sivasundaram L, Heckmann N. , et al. Surgical approach and anesthetic modality for carpal tunnel release: a nationwide database study with health care cost implications. Hand (N Y) 2017; 12 (02) 162-167
    CrossrefPubMedSuche in Google Scholar
  • 28 Maliha SG, Cohen O, Jacoby A, Sharma S. A cost and efficiency analysis of the WALANT technique for the management of trigger finger in a procedure room of a major city hospital. Plast Reconstr Surg Glob Open 2019; 7 (11) e2509
    CrossrefPubMedSuche in Google Scholar
  • 29 Chatterjee A, McCarthy JE, Montagne SA, Leong K, Kerrigan CL. A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States. Ann Plast Surg 2011; 66 (03) 245-248
    CrossrefPubMedSuche in Google Scholar
  • 30 Williamson M, Sehjal R, Jones M, James C, Smith A. How critical cost analysis can save money in today's NHS: a review of carpal tunnel surgery in a district general hospital. BMJ Open Qual 2018; 7 (02) e000115
    CrossrefPubMedSuche in Google Scholar