Cost analysis of carpal tunnel release with local anesthesia vs sedation. A survey of the Argentinian Association of Hand Surgery.

IF 0.5 Q4 SURGERY
Journal of Hand and Microsurgery Pub Date : 2025-01-06 eCollection Date: 2025-03-01 DOI:10.1016/j.jham.2025.100215
Facundo Delgado, Francisco Príncipe, Verónica Andrea Alfie, Mariano Oscar Abrego, Fernando Holc, Pedro Bronenberg Victoria, Jorge Guillermo Boretto, Ignacio Rellan
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Abstract

Purpose: To compare the costs of carpal tunnel release (CTR) performed in a minor procedure room using wide awake local anesthesia no tourniquet (WALANT), local anesthesia with a tourniquet (AL-T) and CTR in a conventional operating room (OR) with sedation. Additionally, we aimed to assess the anesthetic preferences of the Argentine Association of Hand and Upper Limb Reconstructive Surgery (AACM) members regarding CTR.

Material and methods: This cross-sectional, single-center study involved analyzing specific hospital costs associated with each anesthesia technique in both surgical settings. A report was obtained from the OR chief of our institution. Additionally, an anonymous survey was conducted among certified and main AACM members, gathering data on: (1) practice location, (2) preferred anesthesia type for CTR and reasons for not using WALANT/AL-T regularly, (3) years of practice, (4) preferred CTR surgical technique, and (5) willingness to change anesthesia preference if offered differential fees.

Results: Performing CTR with WALANT and AL-T in a procedure room resulted in cost savings of 64 % and 65 %, respectively, compared to sedation in a conventional OR. The average duration for CTR, including cleaning and turnover time, was 34 min (±3) for WALANT, 33 min (±4) for AL-T, and 55 min (±8) for sedation in a conventional operating room.Out of 226 AACM members, 95 (42 %) responded to the survey. Among them, 42 % practiced in Buenos Aires (CABA), and only 35 % preferred using local anesthesia for CTR (16 % WALANT, 19 % AL-T). Nearly half (49 %) had over 16 years of experience. All respondents favored open or mini-approach techniques for CTR. Those who did not use WALANT or AL-T cited discomfort with patient interaction and perceived lack of benefits as reasons. However, 31 % indicated they would change their anesthesia preference if offered differential fees.

Conclusions: CTR with WALANT or AL-T in a procedure room reduces costs by over 65 % compared to sedation in a conventional OR. Despite cost benefits, sedation remains the predominant practice in Argentina, hindered by a lack of consensus and institutional incentives.

局部麻醉与镇静下腕管释放术的成本分析。阿根廷手外科协会的一项调查。
目的:比较在小手术室采用无止血带全醒局麻(WALANT)、带止血带局麻(AL-T)和有镇静的常规手术室(OR)进行腕管释放术(CTR)的成本。此外,我们的目的是评估阿根廷手和上肢重建外科协会(AACM)成员对CTR的麻醉偏好。材料和方法:本横断面单中心研究分析了两种手术环境中与每种麻醉技术相关的具体医院费用。从我们机构的主任那里得到了一份报告。此外,对AACM认证会员和主要会员进行匿名调查,收集以下数据:(1)执业地点,(2)CTR首选麻醉类型和不定期使用WALANT/AL-T的原因,(3)执业年限,(4)首选CTR手术技术,(5)如果提供差异费用,愿意改变麻醉偏好。结果:与传统手术室的镇静相比,在手术室中使用WALANT和AL-T进行CTR分别节省了64%和65%的成本。CTR的平均持续时间,包括清洁和周转时间,在常规手术室中,WALANT为34分钟(±3),AL-T为33分钟(±4),镇静为55分钟(±8)。在226名AACM会员中,95名(42%)回应了调查。其中,42%的人在布宜诺斯艾利斯(CABA)实习,只有35%的人倾向于使用局部麻醉进行CTR(16%的人选择WALANT, 19%的人选择AL-T)。近一半(49%)有超过16年的工作经验。所有受访者都赞成开放或迷你方法技术的点击率。未使用WALANT或AL-T的患者则将与患者互动时的不适和认为缺乏益处作为原因。然而,31%的人表示,如果提供不同的费用,他们会改变麻醉的偏好。结论:与传统手术室的镇静相比,在手术室中使用WALANT或AL-T的CTR可减少65%以上的费用。尽管具有成本效益,但由于缺乏共识和制度性激励,镇静仍然是阿根廷的主要做法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.00
自引率
25.00%
发文量
39
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