From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Ann Plast Surg. 2023 Aug 1;91(2):220-224. doi: 10.1097/SAP.0000000000003646.
Trigger finger release (TFR) has traditionally been performed in outpatient operating rooms. More recently, TFR may be performed in the office setting to achieve greater efficiency and cost savings.
The 2010-2020 Q2 PearlDiver M91Ortho data set was analyzed for cases of TFR. Exclusion criteria were age less than 18 years, <30 days of postoperative records, concomitant hand surgery, monitored anesthesia use, and inpatient surgery. Age, sex, and Elixhauser comorbidity index were recorded. Operating room and office procedures were matched 4:1 based on patient characteristics. Total and physician reimbursement for the day of surgery, as well as 30-day narcotics prescriptions, emergency department (ED) visits, and surgical site infections (SSI) were determined.
Before matching, TFRs were found to be increasingly performed in the office (from 7.9% in 2010 to 14.6% in 2020). Matched cohorts consisted of 63,951 operating room and 15,992 office procedures. Office procedures had lower mean total reimbursements ($435 vs $752, P < 0.001), slightly lower mean physician reimbursements ($420 vs $460, P < 0.001), and lower rates of narcotic prescriptions (30.5% vs 50.5%, P < 0.001) and 30-day ED visits (2.2% vs 2.9%, P < 0.05). There was no difference in 30-day SSI (0.5% vs 0.6%, P = 0.374).
In-office TFR is becoming increasingly prevalent. After matching, in-office TFRs were associated with lesser costs to the system, lower narcotic prescriptions, and fewer postoperative ED visits, without increased SSI. Although it is important to perform procedures in the best location for the patient, physician, and system, the current study supports the increased value offered by in-office TFR.
扳机指松解术（TFR）传统上在门诊手术室进行。最近，TFR 可能在办公室环境中进行，以实现更高的效率和成本节约。
分析了 2010 年至 2020 年第二季度 PearlDiver M91Ortho 数据集的 TFR 病例。排除标准为年龄小于 18 岁、术后记录少于 30 天、同时进行手部手术、使用监测麻醉和住院手术。记录了年龄、性别和 Elixhauser 合并症指数。根据患者特征，将手术室和办公室程序按 4:1 进行匹配。手术当天的总费用和医生报销费用，以及 30 天内的麻醉药处方、急诊就诊和手术部位感染（SSI）情况。
在匹配之前，TFR 越来越多地在办公室进行（从 2010 年的 7.9%到 2020 年的 14.6%）。匹配队列包括 63951 例手术室和 15992 例办公室手术。办公室手术的总报销费用（$435 与 $752，P<0.001）、医生报销费用（$420 与 $460，P<0.001）略低，麻醉药处方（30.5%与 50.5%，P<0.001）和 30 天内急诊就诊（2.2%与 2.9%，P<0.05）率较低。30 天内 SSI 无差异（0.5%与 0.6%，P=0.374）。
在办公室进行 TFR 越来越普遍。匹配后，办公室 TFR 与系统成本降低、麻醉药处方减少和术后急诊就诊减少相关，而 SSI 无增加。尽管在为患者、医生和系统提供最佳治疗位置方面很重要，但本研究支持在办公室进行 TFR 带来的更高价值。
