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Operating Room A1 Pulley Release Versus Wide Awake A1 Pulley Release in the Office and Clinic Settings: A Cost Analysis
Sana Bhatti, M.D.1, Mark G. Albert, M.D.1, Shivani Kumar, B.S.1, James Shenko, M.D.2, Douglas Rothkopf, M.D.1.
1University of Massachusetts, Worcester, MA, USA, 2Private Practice, Worcester, MA, USA.
Background
Wide-awake surgery of the hand (WASH) is a method of performing hand surgery without the use of a tourniquet or IV medication. The technique has been used since the early nineteen nineties, and Lalonde et al have demonstrated the safety, efficacy, and patient satisfaction of WASH in several publications. To date, there are no publications in the literature that compare A1 pulley release in the operating room, clinic and office settings.
Methods
We examined data from 380 patients with a diagnosis of trigger finger treated surgically by 9 plastic surgeons on faculty at the University of Massachusetts Medical Center between October 2010 and July 2014. These surgeons operate in the OR setting only, at one of the UMass outpatient campuses. We compared our data to 2 private practice plastic surgeons who performed A1 pulley releases using only the WASH technique in their office on 477 patients from December 2011 to July 2014. We recently began performing WASH procedures in the clinic of our outpatient teaching hospital, and have included 10 procedures to date in this study by the senior author.
Results
For WASH A1 pulley release, our private surgeons charged \,713 per procedure and were reimbursed on average \ by insurance companies. The cost per procedure was \ and the estimated cost of OR time was \ per procedure. An average profit of \ was gained per procedure.
For traditional A1 pulley release performed with local anesthesia and sedation in the operating room, the average facility charge for the procedure was \,072 and the average reimbursement was \,537. The cost per procedure was \,428, resulting in an average profit of \ per procedure. Our average professional fee profit was \, resulting in a total profit of \ per procedure performed in the operating room.
Conclusions
Given the proven safety, efficacy and patient satisfaction of the technique, hand surgeons should consider adopting WASH as cost-effectiveness becomes increasingly important in the US healthcare system in the future.
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