Simple upper extremity procedures such as A1 pulley release for trigger finger can be performed in a safe and effective manner in the office. Prior literature reports comparable outcome between surgery in the office and the operating room. However, no cost efficiency analysis study has identified in detail the areas for improvement for trigger finger release.
Patients who have undergone trigger finger release without any concurrent procedures were identified from 2017-2018 using cpt code 26055. Surgeries performed either in the operating room (OR) or in the office-based setting (OBS) under field sterility were included. Facility expenses associated with OR and OBS were calculated. Differential itemizable equipment and supplies used in every surgery were compared between OBS and OR to identify additional areas of cost saving.
A total of 76 patients underwent A1 pulley release were included in the study: 39 patients received surgery in the operating room whereas 37 underwent office-based procedures. The average age is 59 [12-78] for OBS and 59 [37-89] for the OR cohort. For OR procedures, the average surgery time is 12 [6-28] minutes, the average time spent in the operating room is 30 [20-41] minutes, and 44% of OR procedures required more than 30 minutes room time. All OBS procedures - up to three trigger finger release - were completed during one 30-minute office visit independent of how many trigger fingers were involved. This translates to a facility cost saving of $375 and anesthesia fees of $216 in OBS compared with OR. Additionally, the standard amount of anesthetics used in OBS is 5 cc as compared to an average of 7 [2-16] cc in the OR. The sterility of OR procedures requires single use of anesthetics for each patient which costs $35.57, as opposed to aliquots of reusable anesthetics in OBS cases that costs $3.53. OR procedures were all conducted using pneumatic tourniquets and none were used in OBS cases, resulting in a cost reduction of $10.27 per procedure in OBS.
This cost analysis study identifies several areas of cost saving measures for trigger finger release in OBS. OBS eliminates both OR facility and anesthesia fees, yet still able to provide patients with adequate anesthesia for the procedure. Field sterility without tourniquet usage in OBS offers sufficient exposure without any negative impact on surgical outcome while creating substantial cost reduction potentials.