RESUMO
OBJECTIVES: In this study, we evaluated the amount of public funds spent on the operative treatment of carpal tunnel syndrome (CTS) in Finland in 2011-2015. DESIGN: A registry-based cost burden study. SETTING: The data were collected in primary and secondary care in both private and public hospitals, covering the whole population of Finland. PARTICIPANTS: We collected the total number of patients with new CTS diagnoses and the total number of patients undergoing surgery from the Care Register for Health Care, Finland's national register. INTERVENTIONS: Open carpal tunnel release (OCTR). OUTCOME MEASURES: We collected the costs of the OCTR procedure from diagnosis-related group prices. The Social Insurance Institution of Finland provided the total amount of euros reimbursed for sick leaves. We then combined the average amount of reimbursed sick leave with our estimated cost of the treatment chain to approximate the average cost per patient. RESULTS: The average amount of public funds used for diagnosing and surgically treating new CTS in 2011-2015 in Finland, including reimbursements for sick leaves, was 2759 per patient in 2015 currency. The average direct procedure cost was 1020. We found no clear trend in total cost per patient, but the proportion of surgically treated patients rose from 63.14% to 73.09%. The total annual cost of these treatments was between 18 128 420 and 22 569 973. CONCLUSIONS: The average amount of public funds used to surgically treat one patient with new CTS in 2011-2015 in Finland was 2759, making the total annual burden 20.7 million.
Assuntos
Síndrome do Túnel Carpal , Sistema de Registros , Licença Médica , Humanos , Finlândia , Síndrome do Túnel Carpal/cirurgia , Síndrome do Túnel Carpal/economia , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Masculino , Feminino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: To improve the delivery of value-based health care, a deeper understanding of the cost drivers in hand surgery is warranted. Time-driven activity-based costing (TDABC) offers a more accurate estimation of resource utilization compared with top-down accounting methods. This study used TDABC to compare the facility costs of open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR). METHODS: We identified 845 consecutive, unilateral carpal tunnel release (516 open, 329 endoscopic) surgeries performed at an orthopaedic specialty hospital between 2015 and 2021. Itemized facility costs were calculated using a TDABC algorithm. Patient demographics, comorbidities, surgical characteristics, and itemized costs were compared between OCTR and ECTR. Multivariate regression was used to determine the independent effect of endoscopic surgery on true facility costs. RESULTS: Total facility costs were $352 higher in ECTR compared with OCTR ($882 versus $530). ECTR cases had higher personnel costs ($499 versus $420), likely because of longer surgical time (15 versus 11 minutes) and total operating room time (35 versus 27 minutes). ECTR cases also had higher supply costs ($383 versus $110). Controlling for demographics and comorbidities, ECTR was associated with an increase in personnel costs of $35.74 (95% CI, $26.32 to $45.15), supply costs of $230.28 (95% CI, $205.17 to $255.39), and total facility costs of $265.99 (95% CI, $237.01 to $294.97) per case. DISCUSSION: Using TDABC, ECTR was 66% more costly to the facility compared with OCTR. To reduce the costs related to endoscopic surgery, efforts to decrease surgical time and negotiate lower ECTR-specific supply costs are warranted. LEVEL OF EVIDENCE: Economic and Decision Analysis Level II.
Assuntos
Síndrome do Túnel Carpal , Endoscopia , Humanos , Síndrome do Túnel Carpal/cirurgia , Síndrome do Túnel Carpal/economia , Endoscopia/economia , Masculino , Feminino , Pessoa de Meia-Idade , Duração da Cirurgia , Custos e Análise de Custo , Idoso , Procedimentos Ortopédicos/economia , Fatores de Tempo , Adulto , Descompressão Cirúrgica/economia , Descompressão Cirúrgica/métodos , Estudos RetrospectivosRESUMO
BACKGROUND: Few studies have examined whether orthopaedic surgery, including hand surgery, is associated with patients' financial health. We sought to understand the level of financial burden and worry for patients undergoing two common hand procedures-carpal tunnel release and open reduction and internal fixation for a distal radius fracture-as well as to determine factors associated with a higher financial burden and worry. QUESTIONS/PURPOSES: In patients undergoing operative treatment for isolated carpal tunnel syndrome with carpal tunnel release or open reduction and internal fixation for a distal radius fracture, we used validated financial burden and worry questionnaires to ask: (1) What percentage of patients report some level of financial burden, and what is the median financial burden composite score? (2) What percentage of patients report some level of financial worry, and what percentage of patients report a high level of financial worry? (3) When accounting for other assessed factors, what patient- and condition-related factors are associated with financial burden? (4) When accounting for other assessed factors, what patient- and condition-related factors are associated with high financial worry? METHODS: In this cross-sectional survey study, a hand and upper extremity database at a single tertiary academic medical center was reviewed for patients 18 years or older undergoing operative treatment in our hand and upper extremity division for an isolated distal radius fracture between October 2017 and October 2019. We then selected all patients undergoing carpal tunnel release during the first half of that time period (given the frequency of carpal tunnel syndrome, a 1-year period was sufficient to ensure comparable patient groups). A total of 645 patients were identified (carpal tunnel release: 60% [384 of 645 patients]; open reduction and internal fixation for a distal radius fracture: 40% [261 of 645 patients). Of the patients who underwent carpal tunnel release, 6% (24 of 384) were excluded because of associated injuries. Of the patients undergoing open reduction and internal fixation for a distal radius fracture, 4% (10 of 261) were excluded because of associated injuries. All remaining 611 patients were approached. Thirty-six percent (223 of 611; carpal tunnel release: 36% [128 of 360]; open reduction and internal fixation: 38% [95 of 251]) of patients ultimately completed two validated financial health surveys: the financial burden composite and financial worry questionnaires. Descriptive statistics were calculated to report the percentage of patients who had some level of financial burden and worry. Further, the median financial burden composite score was determined. The percentage of patients who reported a high level of financial worry was calculated. A forward stepwise regression model approach was used; thus, variables with p values < 0.10 in bivariate analysis were included in the final regression analyses to determine which patient- and condition-related factors were associated with financial burden or high financial worry, accounting for all other measured variables. RESULTS: The median financial burden composite score was 0 (range 0 [lowest possible financial burden] to 6 [highest possible financial burden]), and 13% of patients (30 of 223) reported a high level of financial worry. After controlling for potentially confounding variables like age, insurance type, and self-reported race, the number of dependents (regression coefficient 0.15 [95% CI 0.008 to 0.29]; p = 0.04) was associated with higher levels of financial burden, while retired employment status (regression coefficient -1.24 [95% CI -1.88 to -0.60]; p < 0.001) was associated with lower levels of financial burden. In addition, the number of dependents (odds ratio 1.77 [95% CI 1.21 to 2.61]; p = 0.004) and unable to work or disabled employment status (OR 3.76 [95% CI 1.25 to 11.28]; p = 0.02) were associated with increased odds of high financial worry. CONCLUSION: A notable number of patients undergoing operative hand care for two common conditions reported some degree of financial burden and worry. Patients at higher risk of financial burden and/or worry may benefit from increased resources during their hand care journey, including social work consultation and financial counselors. This is especially true given the association between number of dependents and work status on financial burden and high financial worry. However, future research is needed to determine the return on investment of this resource utilization on patient clinical outcomes, overall quality of life, and well-being. LEVEL OF EVIDENCE: Level III, therapeutic study.
Assuntos
Síndrome do Túnel Carpal/cirurgia , Estresse Financeiro/etiologia , Mãos/cirurgia , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/psicologia , Idoso , Síndrome do Túnel Carpal/economia , Efeitos Psicossociais da Doença , Estudos Transversais , Bases de Dados Factuais , Feminino , Fixação Interna de Fraturas/economia , Fixação Interna de Fraturas/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/economia , Redução Aberta/psicologiaRESUMO
INTRODUCTION: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. METHODS: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. RESULTS: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. DISCUSSION: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.
Assuntos
Síndrome do Túnel Carpal/cirurgia , Eletrodiagnóstico/normas , Gastos em Saúde/normas , Serviços de Saúde do Trabalhador/normas , Medidas de Resultados Relatados pelo Paciente , Indicadores de Qualidade em Assistência à Saúde/normas , Adulto , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/economia , Eletrodiagnóstico/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Resultado do TratamentoRESUMO
Background: Carpal tunnel syndrome (CTS) is one of the most common compressive neuropathies and affects a large amount of individuals. We investigated the direct and indirect cost to society of operative versus nonoperative management of CTS. Methods: A Monte Carlo simulation model was used to estimate the lifetime direct and indirect costs associated with nonoperative and operative treatment of CTS, and its utility to patients. Results: Operative treatment of CTS had a lower total cost and a higher utility when compared with nonoperative treatment. Conclusions: CTS surgery is clearly a cost-effective treatment strategy that should be included in the societal perspective regarding evolving costs and savings associated with health care.
Assuntos
Síndrome do Túnel Carpal , Custos de Cuidados de Saúde , Síndrome do Túnel Carpal/economia , Síndrome do Túnel Carpal/cirurgia , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: The American Society of Anesthesiologists (ASA) Choosing Wisely Top-5 list of activities to avoid includes "Don't obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery - specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal." Accordingly, we define low-value preoperative tests (LVTs) as those performed before minor surgery in patients without significant systemic disease. The objective of the current study was to examine the extent, variability, drivers, and costs of LVTs before carpal tunnel release (CTR) surgeries in the US Veterans Health Administration (VHA). METHODS: Using fiscal year (FY) 2015-2017 data derived from the VHA Corporate Data Warehouse (CDW), we determined the overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days before CTR in ASA physical status (PS) I-II patients. We also examined the patient, procedure, and facility factors associated with receiving ≥1 LVT with mixed-effects logistic regression and the number of tests received with mixed-effects negative binomial regression. RESULTS: From FY15-17, 10,000 ASA class I-II patients received a CTR by 699 surgeons in 125 VHA facilities. Overall, 47.0% of patients had a CTR that was preceded by ≥1 LVT, with substantial variability between facilities (range = 0%-100%; interquartile range = 36.3%), representing $339,717 in costs. Older age and female sex were associated with higher odds of receiving ≥1 LVT. Local versus other modes of anesthesia were associated with lower odds of receiving ≥1 LVT. Several facilities experienced large (>25%) increases or decreases from FY15 to FY17 in the proportion of patients receiving ≥1 LVT. CONCLUSIONS: Counter to guidance from the ASA, we found that almost half of CTRs performed on ASA class I-II VHA patients were preceded by ≥1 LVT. Although the total cost of these tests is relatively modest, CTR is just one of many low-risk procedures (eg, trigger finger release, cataract surgery) that may involve similar preoperative testing practices. These results will inform site selection for qualitative investigation of the drivers of low-value testing and the development of interventions to improve preoperative testing practice, especially in locations where rates of LVT are high.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Síndrome do Túnel Carpal/economia , Síndrome do Túnel Carpal/cirurgia , Custos de Cuidados de Saúde , Cuidados Pré-Operatórios/economia , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/tendências , Síndrome do Túnel Carpal/diagnóstico , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/tendênciasRESUMO
Background: The increased efficiency and cost savings have led many surgeons to move their practice away from the traditional operating room (OR) or outpatient surgery center (OSC) and into the clinic setting. With the cost of health care continuing to rise, the venue with the lowest cost should be utilized. We performed a direct cost analysis of a single surgeon performing an open carpal tunnel release in the OR, OSC, and clinic. Methods: Four treatment groups were prospectively studied: the hospital OR with monitored anesthesia care (OR-MAC), OSC with MAC (OSC-MAC), OSC with local anesthesia (OSC-local), and clinic with local anesthesia (clinic). To determine direct costs, a detailed inventory was recorded including the weight and disposal of medical waste. Indirect costs were not included. Results: Five cases in each treatment group were prospectively recorded. Average direct costs were OR ($213.75), OSC-MAC ($102.79), OSC-local ($55.66), and clinic ($31.71). The average weight of surgical waste, in descending order, was the OR (4.78 kg), OSC-MAC (2.78 kg), OSC-local (2.6 kg), and the clinic (0.65 kg). Using analysis of variance, the clinic's direct costs and surgical waste were significantly less than any other setting (P < .005). Conclusions: The direct costs of an open carpal tunnel release were nearly 2 times more expensive in the OSC compared with the clinic and almost 7 times more expensive in the OR. Open carpal tunnel release is more cost-effective and generates less medical waste when performed in the clinic versus all other surgical venues.
Assuntos
Síndrome do Túnel Carpal/economia , Redução de Custos/métodos , Descompressão Cirúrgica/economia , Instituições de Assistência Ambulatorial/economia , Procedimentos Cirúrgicos Ambulatórios/economia , Anestesia Local/economia , Anestesia Local/métodos , Síndrome do Túnel Carpal/cirurgia , Análise Custo-Benefício , Descompressão Cirúrgica/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Eliminação de Resíduos de Serviços de Saúde/estatística & dados numéricos , Salas Cirúrgicas/economia , Estudos ProspectivosRESUMO
PURPOSE: In order to effectively improve value in health care delivery, providers must thoroughly understand cost drivers. Time-driven activity-based costing (TDABC) is a novel accounting technique that may allow for precise characterization of procedural costs. The purpose of the present study was to use TDABC to characterize costs in a high-volume, low-complexity ambulatory procedure (endoscopic vs open carpal tunnel release [CTR]), identify cost drivers, and inform opportunities for clinical improvement. METHODS: The costs of endoscopic and open CTR were calculated in a matched cohort investigation using TDABC. Detailed process maps including time stamps were created accounting for all clinical and administrative activities for both the endoscopic and the open treatment pathways on the day of ambulatory surgery. Personnel cost rates were calculated accounting for capacity, salary, and fringe benefits. Costs for direct consumable supplies were based on purchase price. Total costs were calculated by aggregating individual resource utilization and time data and were compared between the 2 surgical techniques. RESULTS: Total procedural cost for the endoscopic CTR was 43.9% greater than the open technique ($2,759.70 vs $1,918.06). This cost difference was primarily driven by the disposable endoscopic blade assembly ($217), direct operating room costs related to procedural duration (44.8 vs 40.5 minutes), and physician labor. CONCLUSIONS: Endoscopic CTR is 44% more expensive than open CTR compared with a TDABC methodology at an academic medical center employing resident trainees. Granular cost data may be particularly valuable when comparing these 2 procedures, given the clinical equipoise of the surgical techniques. The identification of specific cost drivers with TDABC allows for targeted interventions to optimize value delivery. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic Analysis II.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Síndrome do Túnel Carpal/economia , Descompressão Cirúrgica/economia , Endoscopia/economia , Centros Médicos Acadêmicos , Síndrome do Túnel Carpal/cirurgia , Estudos de Coortes , Descompressão Cirúrgica/métodos , Humanos , Estados UnidosRESUMO
BACKGROUND: Over 500 000 carpal tunnel releases costing over $2 billion are performed each year in the United States. The study's purpose is to perform a cost-minimizing analysis to identify the least costly strategy for carpal tunnel syndrome treatment utilizing existing success rates based on previously reported literature. METHODS: We evaluate the expected cost of various treatment strategies based on the likelihood of further treatments: (1) a single steroid injection followed by surgical release; (2) up to 2 steroid injections before surgical release; (3) 3 steroid injections before surgery, and (4) immediate surgical release. To reflect costs, we use our institution's billing charges to private payers and reimbursements from Medicare. A range of expected steroid injection success rates are employed based on previously published literature. RESULTS: Immediate surgical release is the costliest treatment with an expected cost of $2149 to $9927 per patient. For immediate surgical release to cost less than a single injection attempt, the probability of surgery after injection would need to exceed 80% in the Medicare reimbursement model and 87% in the institutional billing model. A single steroid injection with subsequent surgery, if needed, amounts to a direct cost savings of $359 million annually compared with immediate surgical release. Three injections before surgery, with "high" expected success rates, represent the cost-minimizing scenario. CONCLUSIONS: Although many factors must be considered when deciding upon treatment for carpal tunnel syndrome, direct payer cost is an important component, and the initial management with steroid injections minimizes these direct payer costs.
Assuntos
Síndrome do Túnel Carpal/economia , Síndrome do Túnel Carpal/cirurgia , Custos e Análise de Custo/métodos , Medicare/economia , Assistência ao Convalescente , Síndrome do Túnel Carpal/tratamento farmacológico , Descompressão Cirúrgica/economia , Descompressão Cirúrgica/métodos , Humanos , Medicare/estatística & dados numéricos , Esteroides/administração & dosagem , Esteroides/economia , Esteroides/uso terapêutico , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: To our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome. METHODS: We did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and ClinicalTrial.gov, number NCT02038452. FINDINGS: Between April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference -0·32; 95% CI -0·48 to -0·16; p=0·0001). No adverse events were reported. INTERPRETATION: A single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care. FUNDING: Arthritis Research UK.
Assuntos
Anti-Inflamatórios/administração & dosagem , Síndrome do Túnel Carpal/terapia , Injeções , Metilprednisolona/análogos & derivados , Contenções , Adulto , Idoso , Síndrome do Túnel Carpal/economia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Metilprednisolona/administração & dosagem , Acetato de Metilprednisolona , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do TratamentoRESUMO
The cost of carpal tunnel release (CTR) surgery can be decreased and patient satisfaction increased by a few relatively simple changes. Although cost estimates vary in the literature, most investigators agree that open CTR costs less than endoscopic CTR, and the clinic procedure room or ambulatory surgery center is cheaper than the ambulatory surgery center, which is less than the hospital. Patient satisfaction can be increased by making office visits more patient-centered and improving the quality of dialogue between the surgeon and patient.
Assuntos
Síndrome do Túnel Carpal/cirurgia , Custos de Cuidados de Saúde , Procedimentos Ortopédicos/economia , Avaliação de Resultados em Cuidados de Saúde/economia , Satisfação do Paciente , Síndrome do Túnel Carpal/economia , Humanos , Procedimentos Ortopédicos/normasRESUMO
OBJECTIVE: Assess the effect of chronic comorbidities on hours and earnings recovery following a carpal tunnel syndrome (CTS) claim. METHODS: The hours and earnings profiles of Washington State workers' compensation claimants with CTS and controls, upper extremity fractures (UEF) claimants, were collected by linking to unemployment insurance data during 2007 to 2014. Chronic comorbidity status was determined from workers' compensation bills. RESULTS: More (43%) CTS claimants had diagnosed chronic comorbidities than UEF (24%). CTS claimants and claimants with multiple chronic comorbidities had significantly higher odds of not working post injury and poorer hours and earnings recovery compared with UEF claimants and those with no chronic comorbidities. CONCLUSIONS: This research suggests that chronic conditions should be considered as barriers to return to work among injured workers.
Assuntos
Síndrome do Túnel Carpal/epidemiologia , Doença Crônica/epidemiologia , Fraturas Ósseas/epidemiologia , Doenças Profissionais/epidemiologia , Indenização aos Trabalhadores/economia , Adulto , Síndrome do Túnel Carpal/economia , Doença Crônica/economia , Comorbidade , Feminino , Humanos , Fraturas do Úmero/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/economia , Fraturas do Rádio/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Fraturas da Ulna/epidemiologia , Washington/epidemiologiaRESUMO
BACKGROUND: Hand surgery under local anesthesia only has been used more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release performed under local anesthesia ("wide-awake local anesthesia no tourniquet," or WALANT) only to carpal tunnel release performed under intravenous sedation. METHODS: A retrospective comparison of intraoperative (operating room) surgical time and postoperative (postanesthesia care unit) time for consecutive carpal tunnel release procedures performed under both intravenous sedation and wide-awake local anesthesia was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost analysis was performed by means of standardized anesthesia billing based on base units, time, and conversion rates. RESULTS: There were no significant differences between the two groups in terms of total operative time, 28 minutes in the intravenous sedation group versus 26 minutes in the wide-awake local anesthesia group. Postanesthesia care unit times were significantly longer in the intravenous sedation group (84 minutes) compared to the wide-awake local anesthesia group (7 minutes). Depending on conversion rates used, a total of $139 to $432 was saved in each case performed with wide-awake local anesthesia by not using anesthesia services. In addition, a range of $1320 to $1613 was saved for the full episode of care, including anesthesia costs, operating room time, and postanesthesia care unit time for each patient undergoing wide-awake local anesthesia carpal tunnel release. CONCLUSION: Carpal tunnel release surgery performed with the wide-awake local anesthesia technique offers significant reduction in cost for use of anesthesia and postanesthesia care unit resources.
Assuntos
Anestésicos Locais , Síndrome do Túnel Carpal/cirurgia , Hipnóticos e Sedativos/administração & dosagem , Período de Recuperação da Anestesia , Síndrome do Túnel Carpal/economia , Custos e Análise de Custo , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , VigíliaRESUMO
OBJECTIVE The epidemiology of carpal tunnel syndrome (CTS) has been extensively researched. However, data describing the economic burden of CTS is limited. The purpose of this study was to quantify the disease burden of CTS and determine the economic benefit of its surgical management. METHODS The authors utilized the PearlDiver database to identify the number of individuals with CTS in the Medicare patient population, and then utilized CPT codes to identify which individuals underwent surgical management. These data were used to calculate the total number of disability-adjusted life years (DALYs) associated with CTS. A human capital approach was employed and gross national income per capita was used to calculate the economic burden. RESULTS From 2005 to 2012 there were 1,500,603 individuals identified in the Medicare patient population with the diagnosis of CTS. Without conservative or surgical management, this results in 804,113 DALYs without age weighting and discounting, and 450,235 DALYs with age weighting and a discount rate of 3%. This amounts to between $21.8 and $39 billion in total economic burden, or $2.7-$4.8 billion per year. Surgical management of CTS has resulted in the aversion of 173,000-309,000 DALYs. This has yielded between $780 million and $1.6 billion in economic benefit per year. Endoscopic carpal tunnel release provided between $11,683 and $23,186 per patient at 100% success while open carpal tunnel release provided between $10,711 and $22,132 per patient at 100% success. The benefit-cost ratio at its most conservative is 2.7:1, yet could be as high as 6.9:1. CONCLUSIONS CTS is prevalent in the Medicare patient population, and is associated with a large amount of economic burden. The surgical management of CTS leads to a large reduction in this burden, yielding extraordinary economic benefit.
Assuntos
Síndrome do Túnel Carpal/economia , Síndrome do Túnel Carpal/cirurgia , Análise Custo-Benefício , Descompressão Cirúrgica/economia , Medicare/economia , Idoso , Idoso de 80 Anos ou mais , Síndrome do Túnel Carpal/epidemiologia , Análise Custo-Benefício/tendências , Descompressão Cirúrgica/tendências , Feminino , Humanos , Masculino , Medicare/tendências , Estados Unidos/epidemiologiaRESUMO
Carpal tunnel release is one of the most common hand operations in the United States and every year approximately 500,000 patients undergo surgical release. In this article, we examine the argument for endoscopic carpal tunnel release versus open carpal tunnel release, as well as some of the literature on anatomical variants in the median nerve at the wrist. We further describe the experience of several surgeons in a large academic practice. The goals of this article are to describe key anatomic findings and to present several cases that have persuaded us to favor offering patients open carpal tunnel release.
Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia , Amiloidose/cirurgia , Calcinose/cirurgia , Síndrome do Túnel Carpal/economia , Descompressão Cirúrgica/economia , Endoscopia/economia , Cistos Glanglionares/cirurgia , Humanos , Nervo Mediano/anormalidades , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Músculo Esquelético/anormalidades , Neurilemoma/cirurgia , Salas Cirúrgicas/economia , Ambulatório Hospitalar/economia , Centros Cirúrgicos/economia , Sinovectomia , Tendinopatia/cirurgia , Tenossinovite/cirurgiaRESUMO
PURPOSE: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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). CLINICAL RELEVANCE: This study identifies modifiable factors that may lead to cost reductions for CTR surgery.
Assuntos
Síndrome do Túnel Carpal/economia , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/economia , Procedimentos Cirúrgicos Ambulatórios/economia , Anestesia Geral/economia , Anestésicos Locais/economia , Anestésicos Locais/uso terapêutico , Custos e Análise de Custo , Descompressão Cirúrgica/métodos , Endoscopia/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/economia , Salas Cirúrgicas/economia , Estudos Retrospectivos , Estados UnidosRESUMO
OBJECTIVES: The Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care. METHODS: Prospective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model. RESULTS: 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity. CONCLUSIONS: Patient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.
Assuntos
Ansiedade/epidemiologia , Síndrome do Túnel Carpal/psicologia , Síndrome do Túnel Carpal/terapia , Depressão/epidemiologia , Estresse Psicológico/epidemiologia , Corticosteroides/administração & dosagem , Idoso , Síndrome do Túnel Carpal/economia , Efeitos Psicossociais da Doença , Estudos Transversais , Descompressão Cirúrgica/efeitos adversos , Inglaterra/epidemiologia , Feminino , Mãos/fisiopatologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Autorrelato , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The impacts of compliance with opioid prescribing guidelines on disability durations and medical costs for carpal tunnel release (CTR) were examined. METHODS: Using a dataset of insured US employees, opioid prescriptions for 7840 short-term disability cases with a CTR procedure were identified. Opioids prescriptions were compared with the American College of Occupational and Environmental Medicine (ACOEM)'s opioid prescribing guidelines for postoperative, acute pain, which recommends no more than a 5-day supply, a maximum morphine equivalent dose of 50âmg/day, and only short-acting opioids. RESULTS: Most cases (70%) were prescribed an opioid and 29% were prescribed an opioid contrary to ACOEM's guidelines. Cases prescribed an opioid contrary to guidelines had disability durations 1.9 days longer and medical costs $422 higher than cases prescribed an opioid according to guidelines. CONCLUSIONS: The use of opioid prescribing guidelines may reduce CTR disability durations and medical costs.
Assuntos
Analgésicos Opioides/uso terapêutico , Síndrome do Túnel Carpal/tratamento farmacológico , Pessoas com Deficiência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Analgésicos Opioides/economia , Síndrome do Túnel Carpal/economia , Síndrome do Túnel Carpal/cirurgia , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/economia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Surgical management of carpal tunnel syndrome (CTS) is performed with an open or endoscopic approach. Current literature suggests that the endoscopic approach is associated with higher costs and a steeper learning curve. This study evaluated the billing and utilization trends of both approaches. METHODS: A retrospective review of a Medicare database within the PearlDiver Supercomputer (Warsaw, IN) was performed for patients undergoing open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) from 2005-2012. Annual utilization, charges, reimbursement, demographic data, and compound annual growth rate (CAGR) were evaluated. RESULTS: Our query returned 1,500,603 carpal tunnel syndrome patients, of which 507,924 (33.8%) and 68,768 (4.6%) were surgically managed with OCTR and ECTR respectively (remainder treated conservatively). Compound annual growth rate was significantly higher in ECTR (5%) than OCTR (0.9%; P < 0.001). Average charges were higher in OCTR ($3820) than ECTR ($2952), whereas reimbursements were higher in ECTR (mean $1643) than OCTR (mean $1312). Both were performed most commonly in the age range of 65-69 y, females, and southern geographic region. CONCLUSIONS: ECTR is growing faster than OCTR in the Medicare population. Contrary to previous literature, our study shows that ECTR had lower charges and reimbursed at a higher rate than OCTR.