Metacarpal Fracture Fixation in a Minor Surgery Setting Versus Main Operating Room: A Cost-minimization Analysis
Anna K Steve, Christaan H Schrag, Alice Kuo, A Robertston Harrop, Anna K Steve, Christaan H Schrag, Alice Kuo, A Robertston Harrop
Abstract
The objective of this study was to compare the costs of performing metacarpal fracture fixation in minor surgery (MS) versus the main operating room (OR) at a tertiary care center in Calgary, Alberta, from the institutional perspective.
Methods: Data were extracted from the Operating Room Information System and the Business Advisory System by a financial analyst. All data were based on actual expenses from the 2016-2017 fiscal year (US$). Direct costs included: staffing, supply, day (outpatient) surgery unit, post-anesthesia care unit (PACU), and anesthesia (anesthesiologist and equipment) costs. Surgeon and hardware costs were deemed neutral and excluded from the analysis.
Results: The total cost of metacarpal fixation in MS was $250, compared to $2,226 in the OR, after surgeon and hardware costs were excluded. Staffing costs are a major contributing factor to cost by location ($75 in MS versus $233 in OR), largely attributable to 0.5 nursing staff per room in MS compared to 3 nursing staff per room in the OR. Supply costs (minor tray, $94 versus case cart, $247) are also greater for OR cases. The combined costs for DSU ($465), PACU ($435), and anesthesia ($247) totaled $1,147 and are only incurred for OR cases.
Conclusions: Repair of metacarpal fractures in MS represents a substantial cost-minimization strategy from the institutional perspective. Staffing and supply costs by location and the additional combined costs of DS, PACU, and anesthesia are all contributing factors.
Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
Figures
References
- Feehan LM, Sheps SB. Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study. J Hand Surg Am. 2006;31:1068–1074.
- Gillis JA, Williams JG. Cost analysis of percutaneous fixation of hand fractures in the main operating room versus the ambulatory setting. J Plast Reconstr Aesthet Surg. 2017;70:1044–1050.
- Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26:908–915.
- Lalonde D. Wide awake local anaesthesia no tourniquet technique (WALANT). BMC Proc. 2015;9(suppl 3):A81.
- Warrender WJ. A cost analysis of carpal tunnel release surgery performed wide awake versus under sedation. Plast Reconstr Surg. 2018;142:1532–1538.
- Robinson R. Costs and cost-minimisation analysis. BMJ. 1993;307:726–728.
- Dua K, Blevins CJ, O’Hara NN, et al. The safety and benefits of the semisterile technique for closed reduction and percutaneous pinning of pediatric upper extremity fractures. [published online ahead of print July 1, 2018] Hand (N Y). doi: 10.1177/1558944718787310.
- Garon MT, Massey P, Chen A, et al. Cost and complications of percutaneous fixation of hand fractures in a procedure room versus the operating room. Hand (N Y). 2018;13:428–434.
- Leblanc MR, Lalonde DH, 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.
Source: PubMed