Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007 Madrid, Spain.
J Ultrasound Med. 2012 Mar;31(3):427-38. doi: 10.7863/jum.2012.31.3.427.
Trigger digit surgery can be performed by an open approach using classic open surgery, by a wide-awake approach, or by sonographically guided first annular pulley release in day surgery and office-based ambulatory settings. Our goal was to perform a turnover and economic analysis of 3 surgical models.
Two studies were conducted. The first was a turnover analysis of 57 patients allocated 4:4:1 into the surgical models: sonographically guided-office-based, classic open-day surgery, and wide-awake-office-based. Regression analysis for the turnover time was monitored for assessing stability (R(2) < .26). Second, on the basis of turnover times and hospital tariff revenues, we calculated the total costs, income to cost ratio, opportunity cost, true cost, true net income (primary variable), break-even points for sonographically guided fixed costs, and 1-way analysis for identifying thresholds among alternatives.
Thirteen sonographically guided-office-based patients were withdrawn because of a learning curve influence. The wide-awake (n = 6) and classic (n = 26) models were compared to the last 25% of the sonographically guided group (n = 12), which showed significantly less mean turnover times, income to cost ratios 2.52 and 10.9 times larger, and true costs 75.48 and 20.92 times lower, respectively. A true net income break-even point happened after 19.78 sonographically guided-office-based procedures. Sensitivity analysis showed a threshold between wide-awake and last 25% sonographically guided true costs if the last 25% sonographically guided turnover times reached 65.23 and 27.81 minutes, respectively. However, this trial was underpowered.
This trial comparing surgical models was underpowered and is inconclusive on turnover times; however, the sonographically guided-office-based approach showed shorter turnover times and better economic results with a quick recoup of the costs of sonographically assisted surgery.
触发指手术可以通过开放式手术（经典开放式手术）、清醒手术或超声引导下的第一环状滑车松解术在日间手术和门诊环境下进行。我们的目标是对 3 种手术模型进行周转率和经济分析。
进行了两项研究。第一项是对 57 名患者进行周转率分析，将患者 4:4:1 分配到手术模型中：超声引导下门诊手术、经典日间手术和清醒门诊手术。监测回归分析的周转率，以评估稳定性（R²<0.26）。其次，根据周转率和医院收费标准，我们计算了总成本、收支比、机会成本、实际成本、实际净收入（主要变量）、超声引导固定成本的盈亏平衡点以及识别替代方案之间阈值的单因素分析。
由于学习曲线的影响，13 名超声引导下门诊手术的患者被撤出。清醒手术（n=6）和经典手术（n=26）与超声引导组最后 25%的患者（n=12）进行比较，发现清醒手术和经典手术的平均周转率显著降低，收入成本比分别为 2.52 倍和 10.9 倍，实际成本分别为 75.48 倍和 20.92 倍。超声引导门诊手术达到 19.78 例时出现实际净收入盈亏平衡点。敏感性分析显示，如果超声引导下门诊手术最后 25%的周转率分别达到 65.23 分钟和 27.81 分钟，则清醒手术和超声引导下门诊手术的最后 25%的实际成本之间存在一个阈值。然而，本试验的效力不足。
本试验对手术模型的比较效力不足，周转率的结论不确定；然而，超声引导下门诊手术的周转率更短，经济结果更好，超声辅助手术的成本能够快速收回。
