Kazmers Nikolas H, Presson Angela P, Xu Yizhe, Howenstein Abby, Tyser Andrew R
Department of Orthopaedics, University of Utah, Salt Lake City, UT.
Division of Public Health, University of Utah, Salt Lake City, UT; Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, UT.
J Hand Surg Am. 2018 Nov;43(11):971-977.e1. doi: 10.1016/j.jhsa.2018.03.051. Epub 2018 May 18.
Carpal tunnel release (CTR) is a common surgical procedure, representing a financial burden to the health care system. The purpose of this study was to test whether the choice of CTR technique (open carpal tunnel release [OCTR] vs endoscopic carpal tunnel release [ECTR]), surgical setting (operating room vs procedure room [PR]), and anesthetic type (local, monitored anesthesia care [MAC], Bier block, general) affected costs or payments.
Consecutive adult patients undergoing isolated unilateral CTR between July 2014, and October 2017, at a single academic medical center were identified. Patients undergoing ECTR converted to OCTR, revision surgery, or additional procedures were excluded. Using our institution's information technology value tools, we calculated total direct costs (TDCs), total combined payment (TCP), hospital payment, surgeon payment, and anesthesia payment for each surgical encounter. Cost data were normalized using each participant's surgical encounter cost divided by the average cost in the data set and compared across 8 groups (defined by surgery type, operation location, and anesthesia type).
Of 479 included patients, the mean age was 55.3 ± 16.1 years, and 68% were female. Payer mix included commercial (45%), Medicare (37%), Medicaid (13%), workers' compensation (2%), self-pay (1%), and other (3%) insurance types. The TDC and TCP both differed significantly between each CTR group, and OCTR in the PR under local anesthesia was the lowest. The OCTR/local/operating room, OCTR/MAC/operating room, and ECTR/operating room, were associated with 6.3-fold, 11.0-fold, and 12.4-16.6-fold greater TDC than OCTR/local/PR, respectively.
Performing OCTR under local anesthetic in the PR setting significantly minimizes direct surgical encounter costs relative to other surgical methods (ECTR), anesthetic methods (Bier block, MAC, general), and surgical settings (operating room).
This study identifies modifiable factors that may lead to cost reductions for CTR surgery.
腕管松解术（CTR）是一种常见的外科手术，给医疗保健系统带来了经济负担。本研究的目的是测试CTR技术的选择（开放式腕管松解术[OCTR]与内镜下腕管松解术[ECTR]）、手术环境（手术室与诊疗室[PR]）以及麻醉类型（局部麻醉、监护性麻醉护理[MAC]、静脉 Bier 阻滞麻醉、全身麻醉）是否会影响成本或支付费用。
确定了 2014 年 7 月至 2017 年 10 月期间在一家学术医疗中心接受孤立性单侧 CTR 的连续成年患者。排除了接受 ECTR 转为 OCTR、翻修手术或其他手术的患者。使用我们机构的信息技术价值工具，我们计算了每次手术的总直接成本（TDC）、总综合支付（TCP）、医院支付、外科医生支付和麻醉支付。成本数据通过将每个参与者的手术成本除以数据集中的平均成本进行标准化，并在 8 组（由手术类型、手术地点和麻醉类型定义）之间进行比较。
在纳入的 479 例患者中，平均年龄为 55.3±16.1 岁，68%为女性。支付方组合包括商业保险（45%）、医疗保险（37%）、医疗补助（13%）、工伤赔偿（2%）、自费（1%）和其他（3%）保险类型。每个 CTR 组之间的 TDC 和 TCP 均有显著差异，局部麻醉下在诊疗室进行的 OCTR 成本最低。与局部麻醉下在诊疗室进行的 OCTR 相比，局部麻醉下在手术室进行的 OCTR、MAC 麻醉下在手术室进行的 OCTR 以及在手术室进行的 ECTR 的 TDC 分别高出 6.3 倍、11.0 倍和 12.4 - 16.6 倍。
与其他手术方法（ECTR）、麻醉方法（静脉 Bier 阻滞麻醉、MAC、全身麻醉）和手术环境（手术室）相比，在诊疗室环境下进行局部麻醉的 OCTR 可显著降低直接手术成本。
本研究确定了可能导致 CTR 手术成本降低的可改变因素。
