Purpose
The annual high volume of carpal tunnel releases (CTRs) has a large financial impact
on the health care system. Validating the cost drivers related to CTR in a large,
diverse patient population may aid in developing cost reduction strategies to benefit
health care systems.
Methods
Adult patients with carpal tunnel syndrome who underwent CTR were identified in the
New York Statewide Planning and Research Cooperative System database from 2016 to
2017. The Statewide Planning and Research Cooperative System is a comprehensive all-payer
database that collects all inpatient and outpatient preadjudicated claims in New York.
A multivariable mixed model regression with random effects was performed for the facility
to assess the variables that contributed significantly to the total charge. The variables
included were patient age, sex, anesthesia method, whether the surgery took place
in an ambulatory surgery center or a hospital outpatient department, operation time
in minutes, primary insurance type, race, ethnicity, Charlson Comorbidity Index, and
categories for billed procedure codes.
Results
During the period of 2016 to 2017, 8,717 claims were included, with a mean charge
per claim of $4,865. General anesthesia was associated with higher charges than local
anesthesia. A procedure at a hospital outpatient department was associated with an
approximately 48.2% increase in the total charge compared with that at an ambulatory
surgery center. A 1-minute increase in the operation time was associated with a 0.3%
increase in the total charge. Claims with antiemetics, antihistamines, benzodiazepines,
intravenous fluids, narcotic agents, or preoperative antibiotics were associated with
higher total charges than claims that did not bill for these. Compared with endoscopic
procedures, open procedures had a 44.3% decrease in the total charges.
Conclusions
This comprehensive multivariable model has validated that general anesthesia, hospital-based
surgery, the use of antibiotics and opioids, longer operative times, and endoscopic
CTR significantly increased the cost of surgery.
Type of study/level of evidence
Economic and decision analyses II.
Key words
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Article info
Publication history
Published online: December 27, 2021
Accepted:
October 6,
2021
Received:
January 3,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
