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A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation.
Plast Reconstr Surg. 2018 12; 142(6):1532-1538.PR

Abstract

BACKGROUND

Hand surgery under local anesthesia only has been used more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release performed under local anesthesia ("wide-awake local anesthesia no tourniquet," or WALANT) only to carpal tunnel release performed under intravenous sedation.

METHODS

A retrospective comparison of intraoperative (operating room) surgical time and postoperative (postanesthesia care unit) time for consecutive carpal tunnel release procedures performed under both intravenous sedation and wide-awake local anesthesia was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost analysis was performed by means of standardized anesthesia billing based on base units, time, and conversion rates.

RESULTS

There were no significant differences between the two groups in terms of total operative time, 28 minutes in the intravenous sedation group versus 26 minutes in the wide-awake local anesthesia group. Postanesthesia care unit times were significantly longer in the intravenous sedation group (84 minutes) compared to the wide-awake local anesthesia group (7 minutes). Depending on conversion rates used, a total of $139 to $432 was saved in each case performed with wide-awake local anesthesia by not using anesthesia services. In addition, a range of $1320 to $1613 was saved for the full episode of care, including anesthesia costs, operating room time, and postanesthesia care unit time for each patient undergoing wide-awake local anesthesia carpal tunnel release.

CONCLUSION

Carpal tunnel release surgery performed with the wide-awake local anesthesia technique offers significant reduction in cost for use of anesthesia and postanesthesia care unit resources.

Authors+Show Affiliations

From the Rothman Institute at the Thomas Jefferson University.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30188472

Citation

Alter, Todd H., et al. "A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake Versus Under Sedation." Plastic and Reconstructive Surgery, vol. 142, no. 6, 2018, pp. 1532-1538.
Alter TH, Warrender WJ, Liss FE, et al. A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation. Plast Reconstr Surg. 2018;142(6):1532-1538.
Alter, T. H., Warrender, W. J., Liss, F. E., & Ilyas, A. M. (2018). A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation. Plastic and Reconstructive Surgery, 142(6), 1532-1538. https://doi.org/10.1097/PRS.0000000000004983
Alter TH, et al. A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake Versus Under Sedation. Plast Reconstr Surg. 2018;142(6):1532-1538. PubMed PMID: 30188472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation. AU - Alter,Todd H, AU - Warrender,William J, AU - Liss,Frederic E, AU - Ilyas,Asif M, PY - 2018/9/7/pubmed PY - 2019/3/20/medline PY - 2018/9/7/entrez SP - 1532 EP - 1538 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 142 IS - 6 N2 - BACKGROUND: Hand surgery under local anesthesia only has been used more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release performed under local anesthesia ("wide-awake local anesthesia no tourniquet," or WALANT) only to carpal tunnel release performed under intravenous sedation. METHODS: A retrospective comparison of intraoperative (operating room) surgical time and postoperative (postanesthesia care unit) time for consecutive carpal tunnel release procedures performed under both intravenous sedation and wide-awake local anesthesia was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost analysis was performed by means of standardized anesthesia billing based on base units, time, and conversion rates. RESULTS: There were no significant differences between the two groups in terms of total operative time, 28 minutes in the intravenous sedation group versus 26 minutes in the wide-awake local anesthesia group. Postanesthesia care unit times were significantly longer in the intravenous sedation group (84 minutes) compared to the wide-awake local anesthesia group (7 minutes). Depending on conversion rates used, a total of $139 to $432 was saved in each case performed with wide-awake local anesthesia by not using anesthesia services. In addition, a range of $1320 to $1613 was saved for the full episode of care, including anesthesia costs, operating room time, and postanesthesia care unit time for each patient undergoing wide-awake local anesthesia carpal tunnel release. CONCLUSION: Carpal tunnel release surgery performed with the wide-awake local anesthesia technique offers significant reduction in cost for use of anesthesia and postanesthesia care unit resources. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/30188472/A_Cost_Analysis_of_Carpal_Tunnel_Release_Surgery_Performed_Wide_Awake_versus_under_Sedation_ L2 - http://Insights.ovid.com/pubmed?pmid=30188472 DB - PRIME DP - Unbound Medicine ER -