Advertisement

Optimizing the Use of Operating Rooms by Transitioning Common Hand Surgeries Into the Office Setting

Published:January 17, 2023DOI:https://doi.org/10.1016/j.jhsa.2022.11.010

      Purpose

      The purpose of this study was to examine the true monetary implications, at the health system level, of moving simple hand procedures, performed with wide-awake local anesthesia no tourniquet surgery, from the ambulatory surgery center (ASC) to office setting.

      Methods

      We analyzed the costs, revenues, case times, and patient demographics for 2 cohorts of patients who underwent hand and non-hand surgical procedures over a 2-year period. We calculated the mean margin per minute for the top 5 procedures in non-hand orthopedic surgery subgroups, complex plastics hand, and non-hand plastic surgery. We then calculated the following: (1) hours operating room or ASC time gained by moving hand procedures to the office, (2) additional subgroup patients theoretically treated by using the ASC hours gained, and (3) net margin (in dollars) because of additional procedures.

      Results

      Six board-certified hand surgeons performed 623 simple ASC and 808 in-office procedures, consisting of 795 carpal tunnel releases, 84 first dorsal compartment releases, and 446 trigger finger releases. The net margin per minute for simple ASC and in-office hand procedures was $25.01/min and $5.63/min, respectively. In the office setting, hand surgery freed up 821 hours of ASC time, which could be theoretically used to treat over 300 additional patients awaiting outpatient orthopedic hand or plastic surgery. Depending on the subspecialty and type of substituted cases, the theoretical net margin varied from −$150,413 to $3.9 million.

      Conclusions

      Transitioning simple hand operations out of ASCs realized a mean cost savings of 82% per case ($1,137 vs $206) and effectively opened 821 additional hours of operating room time over a 2-year period.

      Clinical relevance

      Transitioning simple hand operations out of the operating room setting and into the office setting reduces the cost of hand surgical care, improves operating room access for alternate procedures or patients, and validates the sustainability of safe and effective wide-awake local anesthesia no tourniquet surgery from a hospital system’s financial standpoint.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Medicare and Medicaid Services
        The National Health Expenditure Accounts.
        • Lalonde D.
        • Bell M.
        • Benoit P.
        • Sparkes G.
        • Denkler K.
        • Chang P.
        A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase.
        J Hand Surg Am. 2005; 30: 1061-1067
        • Bravo D.
        • Gaston R.G.
        • Melamed E.
        Environmentally responsible hand surgery: past, present, and future.
        J Hand Surg Am. 2020; 45: 444-448
        • Kazmers N.H.
        • Presson A.P.
        • Xu Y.
        • Howenstein A.
        • Tyser A.R.
        Cost implications of varying the surgical technique, surgical setting, and anesthesia type for carpal tunnel release surgery.
        J Hand Surg Am. 2018; 43: 971-977
        • Rhee P.
        • Fischer M.
        • Rhee L.
        • McMillan H.
        • Johnson A.E.
        Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures.
        J Hand Surg Am. 2017; 42: e139-e147
        • Lalonde D.H.
        Latest advances in wide awake hand surgery.
        Hand Clin. 2019; 35: 1-6
        • Leblanc M.R.
        • Lalonde J.
        • Lalonde D.H.
        A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada.
        Hand (N Y). 2007; 2: 173-178
        • LeBlanc M.R.
        • Lalonde D.H.
        • Thoma A.
        • et al.
        Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery.
        Hand (N Y). 2011; 6: 60-63
        • Maliha S.G.
        • Cohen O.
        • Jacoby A.
        • Sharma S.
        A cost and efficiency analysis of the WALANT technique for the management of trigger finger in a procedure room of a major city hospital.
        Plast Reconst Surg Glob Open. 2019; 7e2509
        • Steiner M.M.
        • Calandruccio J.H.
        Use of wide-awake local anesthesia no tourniquet in hand and wrist surgery.
        Orthop Clin North Am. 2017; 49: 63-68
        • Yu J.
        • Ji T.
        • Craig M.
        • McKee D.
        • Lalonde D.
        Evidence-based sterility: the evolving role of field sterility in skin and minor hand surgery.
        Plast Reconstr Surg Glob Open. 2019; 7e2481
        • Tang J.B.
        • Xing S.G.
        • Ayhan E.
        • Hediger S.
        • Huang S.
        Impact of wide-awake local anesthesia no tourniquet on departmental settings, cost, patient and surgeon satisfaction, and beyond.
        Hand Clin. 2019; 35: 29-34
        • Alokozai A.
        • Crijns T.J.
        • Janssen S.J.
        • et al.
        Cost in hand surgery: the patient perspective.
        J Hand Surg Am. 2019; 44: 992.e1-992.e26
        • Davison P.G.
        • Cobb T.
        • Lalonde D.H.
        The patient’s perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study.
        Hand (N Y). 2013; 8: 47-53
        • Chatterjee A.
        • McCarthy J.E.
        • Montagne S.A.
        • Leong K.
        • Kerrigan C.L.
        A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States.
        Ann Plast Surg. 2011; 66: 245-248
        • Grandizio L.C.
        • Graham J.
        • Klena J.C.
        Current trends in WALANT surgery: a survey of American Society for Surgery of the Hand Members.
        J Hand Surg Glob Open. 2020; 2: 186-190
        • Woolson S.T.
        • Kang M.N.
        A comparison of the results of total hip and knee arthroplasty performed on a teaching service or a private practice service.
        J Bone Joint Surg Am. 2007; 89: 601-607
        • Green B.H.
        • Lalonde D.H.
        • Seal S.K.
        Incidence of the “adrenaline rush” and vasovagal response with local anesthetic injection.
        Plast Reconstr Surg Glob Open. 2021; 9: e3659