Value of Carpal Tunnel Release in Different Surgical Settings

Background   

Prior studies have demonstrated that transitioning surgeries from a hospital outpatient department (HOPD) to an ambulatory surgical center (ASC) is associated with lower costs and presumably similar outcomes. While these findings assume ASCs generate greater value than HOPDs, no studies have been performed that simultaneously evaluate cost and outcomes using a value formula. With approximately 500,000 carpal tunnel release (CTR) surgeries annually, CTR offers an opportunity to determine the value for one of the most performed upper extremity surgeries. We aim to quantify the value of an endoscopic carpal tunnel release in a HOPD compared to an ASC by analyzing differences in costs and patient outcomes. We hypothesize the ASC will provide greater value by lowering costs and maintaining patient outcomes.    

Methods 

Total costs were comprised of time-driven activity-based labor costs (TDABC), activity-based supply costs (ABC), and claims-based facility costs. Differences in pre-operative and three-month post-operative PROMIS UE and PI scores were calculated to determine PROMIS-adjusted life-years (PALY UE/PI). Total costs were divided by PALYs gained for each PROM to calculate the Value UE/PI of each cohort. The magnitude of the difference in value between cohorts was elucidated by calculating incremental cost-effectiveness ratios (ICERs).   

Results

Patients were collected for each cohort. The ASC generated 28% lower costs compared to the HOPD ($3,370.73 ± $128.80 vs $4,654.75 ± $140.19) (p<0.001). For both PROMIS UE and PI, average PALY gain was not significantly greater for patients at the ASC compared to the HOPD (PALYUE 1.06 vs 0.89 (p=0.24); PALYPI 1.22 vs 0.92 (p=0.48)). The ASC demonstrated between 40-45% greater value, represented by a lower cost/PALYs, compared to the HOPD (Value UE $3,168.81/PALY vs $5,242.78/PALY, Value PI $2,759.90/PALY vs $5,038.04/PALY).   

Conclusions

We observed between 40-45% greater value by performing CTRs in the ASC relative to the HOPD. While the ASC lowered costs by 28%, costs alone do not fully explain the value differential. Patient reported outcomes serve a valuable role in providing a more holistic picture of the value being delivered to patients. Providers can use this information to guide patient decision-making regarding operative treatment options for carpal tunnel syndrome.