Purpose
To improve value in health care delivery, a deeper understanding of the cost drivers
in hand surgery is necessary. Time-driven activity-based costing (TDABC) more accurately
reflects true resource use compared with traditional accounting methods. This study
used TDABC to explore the facility cost of carpal tunnel release and identify preoperative
characteristics of high-cost patients.
Methods
Using TDABC, we calculated the facility costs of 516 consecutive patients undergoing
open carpal tunnel release at an orthopedic specialty hospital between 2015 and 2021.
Patients in the top decile cost were defined as high-cost patients. Multivariable
logistic regression was used to determine preoperative characteristics (age, sex,
body mass index, race, ethnicity, Elixhauser comorbidity index, American Society of
Anesthesiology score, preoperative Disabilities of the Arm, Shoulder and Hand score,
Short-Form 12, and anesthesia type) independently associated with high-cost patients.
Results
Surgery-related personnel costs were the main driver (38.0%) of total facility costs,
followed by preoperative personnel costs (21.3%). There was a 1.8-fold variation in
facility cost between patients in the 90th and 10th percentiles ($774.69 vs $431.35),
with the widest cost variations belonging to medication costs ($17.67 vs $1.85; variation,
9.6-fold) and other supply costs ($213.56 vs $65.56; variation, 3.3-fold). Using multivariable
regression, predictors of high cost were patient age and use of general anesthesia.
Total facility costs correlated strongly with the total operating room time and incision
to closure time.
Conclusions
Efforts to decrease operating room time may translate into reduced personnel costs
and greater cost savings. Multidisciplinary initiatives to control medication expenses
for patients at risk of high costs may narrow the existing variation in costs.
Type of study/level of evidence
Economic and Decision Analysis II.
Key words
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Article info
Publication history
Published online: February 23, 2023
Accepted:
January 18,
2023
Received:
September 15,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
