Brodeur Peter G, Raducha Jeremy E, Patel Devan D, Cruz Aristides I, Gil Joseph A
Warren Alpert Medical School of Brown University, Providence, RI.
Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
J Hand Surg Am. 2022 Mar;47(3):258-265.e1. doi: 10.1016/j.jhsa.2021.10.022. Epub 2021 Dec 27.
The annual high volume of carpal tunnel releases (CTRs) has a large financial impact on the health care system. Validating the cost drivers related to CTR in a large, diverse patient population may aid in developing cost reduction strategies to benefit health care systems.
Adult patients with carpal tunnel syndrome who underwent CTR were identified in the New York Statewide Planning and Research Cooperative System database from 2016 to 2017. The Statewide Planning and Research Cooperative System is a comprehensive all-payer database that collects all inpatient and outpatient preadjudicated claims in New York. A multivariable mixed model regression with random effects was performed for the facility to assess the variables that contributed significantly to the total charge. The variables included were patient age, sex, anesthesia method, whether the surgery took place in an ambulatory surgery center or a hospital outpatient department, operation time in minutes, primary insurance type, race, ethnicity, Charlson Comorbidity Index, and categories for billed procedure codes.
During the period of 2016 to 2017, 8,717 claims were included, with a mean charge per claim of $4,865. General anesthesia was associated with higher charges than local anesthesia. A procedure at a hospital outpatient department was associated with an approximately 48.2% increase in the total charge compared with that at an ambulatory surgery center. A 1-minute increase in the operation time was associated with a 0.3% increase in the total charge. Claims with antiemetics, antihistamines, benzodiazepines, intravenous fluids, narcotic agents, or preoperative antibiotics were associated with higher total charges than claims that did not bill for these. Compared with endoscopic procedures, open procedures had a 44.3% decrease in the total charges.
This comprehensive multivariable model has validated that general anesthesia, hospital-based surgery, the use of antibiotics and opioids, longer operative times, and endoscopic CTR significantly increased the cost of surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and decision analyses II.
每年大量的腕管松解术（CTR）对医疗保健系统产生了巨大的经济影响。在一个庞大且多样化的患者群体中验证与CTR相关的成本驱动因素，可能有助于制定成本降低策略，从而使医疗保健系统受益。
在纽约全州规划与研究合作系统数据库中识别出2016年至2017年期间接受CTR的成年腕管综合征患者。全州规划与研究合作系统是一个综合性的全支付者数据库，收集纽约所有住院和门诊的预裁决索赔。对医疗机构进行了具有随机效应的多变量混合模型回归，以评估对总费用有显著贡献的变量。纳入的变量包括患者年龄、性别、麻醉方法、手术是在门诊手术中心还是医院门诊部进行、手术时间（以分钟计）、主要保险类型、种族、民族、查尔森合并症指数以及计费程序代码类别。
在2016年至2017年期间，共纳入8717份索赔，每份索赔的平均费用为4865美元。全身麻醉的费用高于局部麻醉。与门诊手术中心相比，在医院门诊部进行手术的总费用增加了约48.2%。手术时间每增加1分钟，总费用增加0.3%。开具了止吐药、抗组胺药、苯二氮䓬类药物、静脉输液、麻醉剂或术前抗生素的索赔与未开具这些药物的索赔相比，总费用更高。与内镜手术相比，开放手术的总费用降低了44.3%。
这个综合性的多变量模型已经验证，全身麻醉、基于医院的手术、抗生素和阿片类药物的使用、较长的手术时间以及内镜CTR显著增加了手术成本。
研究类型/证据水平：经济与决策分析II。
