Yale School of Medicine.
From the Division of Plastic Surgery, Department of Surgery.
Plast Reconstr Surg. 2024 Jul 1;154(1):143-149. doi: 10.1097/PRS.0000000000010961. Epub 2023 Aug 3.
Office-based surgery can increase logistical and financial efficiency for patients and surgeons. The current study compares wide-awake, office-based carpal tunnel release to wide-awake operations performed in the operating room in terms of volume, financial burden, narcotic prescriptions, and adverse events.
Operations performed under local-only anesthesia from 2010 to 2020 were identified in a national administrative database (PearlDiver). Patients were grouped by surgical setting and matched based on age, sex, comorbidity burden, and geographic region. Primary endpoints included total disbursement and physician reimbursement, and 30-day narcotics prescriptions, emergency department (ED) visits, and surgical site infections (SSIs).
Before matching, there were 303,741 operating room operations and 5463 office operations. From 2010 to 2020, the percentage of operations in the office increased from 1.2% to 3.4%. Matched cohorts included 21,835 operating room operations and 5459 office operations. Office surgery was associated with lower total disbursement and physician reimbursement for patients with commercial insurance, Medicaid, and Medicare. Linear regression modeling indicated that office-based surgery was significantly associated with lower total disbursement and physician reimbursement. Fewer office patients filled narcotic prescriptions and visited the ED, and there was no difference in SSIs.
Compared with operating room surgery, office surgery was associated with lower financial burden, fewer narcotics prescriptions and ED visits, and a similar incidence of SSIs. These findings, together with literature showing greater efficiency in the office, suggest that office-based operations are safe and cost-effective and should continue to grow.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
开展门诊手术可以提高患者和外科医生的后勤和经济效率。本研究将在办公室进行的清醒状态下腕管松解术与在手术室进行的清醒状态下手术进行比较，比较的指标包括手术量、经济负担、阿片类药物处方和不良事件。
在全国行政数据库（PearlDiver）中确定了 2010 年至 2020 年期间仅行局部麻醉的手术。根据手术环境将患者分组，并根据年龄、性别、合并症负担和地理位置进行匹配。主要终点包括总支出和医生报酬，以及 30 天内的阿片类药物处方、急诊（ED）就诊和手术部位感染（SSI）。
在匹配之前，手术室手术有 303741 例，办公室手术有 5463 例。从 2010 年到 2020 年，办公室手术的比例从 1.2%增加到 3.4%。匹配队列包括 21835 例手术室手术和 5459 例办公室手术。对于有商业保险、医疗补助和医疗保险的患者，门诊手术的总支出和医生报酬较低。线性回归模型表明，与手术室手术相比，门诊手术与较低的总支出和医生报酬显著相关。门诊患者开阿片类药物处方和去急诊就诊的人数较少，且 SSI 发生率无差异。
与手术室手术相比，门诊手术与较低的经济负担、较少的阿片类药物处方和 ED 就诊以及相似的 SSI 发生率相关。这些发现与文献中显示的在办公室更高的效率相结合，表明门诊手术是安全且具有成本效益的，应该继续发展。
临床问题/证据水平：治疗性，III 级。
