Safety And Cost Of Minor Hand Surgery Procedures: A Comparison Across Operative Settings
Jessica I. Billig, MD, MS1, Jacob S. Nasser, BS2, Yu-Ting Lu, MPH1, Jung-Sheng Chen, MS3, Kevin C. Chung, MD, MS1, Chang-Fu Kuo, MD4, Erika D. Sears, MD, MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Georgetown University, Washington, DC, USA, 3Chang Gung Memorial Hospital, Taoyuan, Taiwan, 4Chang Gun Memorial Hospital, Taoyuan, Taiwan.
PURPOSE: Hand surgery can be performed in different operative settings, which may be associated with cost variation, but the impact on patient safety and patient costs is unknown. We sought to examine differences in complications, total cost, and out-of-pocket (OOP) expenses for minor hand surgery procedures performed in office, ambulatory surgery center (ASC), and outpatient hospital (OH) operative settings.
METHODS: We conducted a retrospective cohort study of patients undergoing carpal tunnel release, trigger finger release, excision of wrist ganglion, and excision of small hand masses using the IBM MarketScan Databases (2009-2017). We performed multivariable regression to examine the relationship between operative setting and complications, total cost, and OOP expenses.
RESULTS: Of 468,365 hand surgery procedures evaluated, complications occurred in 3.4% of procedures performed in OHs, 3.3% in ASCs, and 2.9% in office settings (P=<0.001) within 90-days postoperatively. After controlling for patient characteristics, procedures performed outside of the office had significantly greater odds of complications (OR:1.32, 95%CI: 1.22-1.43 in OHs; OR:1.24, 95%CI: 1.24-1.34 in ASCs). Compared to the office setting, procedures performed in OHs incurred an extra $1,216 in total costs (95%CI: $1,184-$1,248) and $115 in OOP expenses (95%CI: $109-$121). Similarly, procedures performed in ASCs cost an additional $709 (95%CI: $676-$741) and $140 in OOP expenses (95%CI: $134-$146).
CONCLUSION: Minor hand surgery performed in the office is less costly and safe relative to ambulatory and hospital-based operative settings. Shifting these procedures to the office may lead to decreased payer costs and decreased patient financial burden without compromising care quality.
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