Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 2: randomized comparative study of the economic impact of 3 surgical models

• Published in: Journal of ultrasound in medicine 2012-03, Vol.31 (3), p.427-438
• Main Authors: Rojo-Manaute, Jose Manuel, Capa-Grasa, Alberto, Cerro-Gutierrez, Miguel Del, Martinez, Manuel Villanueva, Chana-Rodriguez, Francisco, Martin, Javier Vaquero
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory Surgical Procedures - economics; Ambulatory Surgical Procedures - methods; Clinical Competence; Cost-Benefit Analysis; Female; Humans; Male; Middle Aged; Regression Analysis; Treatment Outcome; Trigger Finger Disorder - diagnostic imaging; Trigger Finger Disorder - surgery; Ultrasonography, Interventional - methods
• ISSN: 0278-4297; 1550-9613
• DOI: 10.7863/jum.2012.31.3.427

Trigger digit surgery can be performed by an open approach using classic open surgery, by a wide-awake approach, or by sonographically guided first annular pulley release in day surgery and office-based ambulatory settings. Our goal was to perform a turnover and economic analysis of 3 surgical models. Two studies were conducted. The first was a turnover analysis of 57 patients allocated 4:4:1 into the surgical models: sonographically guided-office-based, classic open-day surgery, and wide-awake-office-based. Regression analysis for the turnover time was monitored for assessing stability (R(2) < .26). Second, on the basis of turnover times and hospital tariff revenues, we calculated the total costs, income to cost ratio, opportunity cost, true cost, true net income (primary variable), break-even points for sonographically guided fixed costs, and 1-way analysis for identifying thresholds among alternatives. Thirteen sonographically guided-office-based patients were withdrawn because of a learning curve influence. The wide-awake (n = 6) and classic (n = 26) models were compared to the last 25% of the sonographically guided group (n = 12), which showed significantly less mean turnover times, income to cost ratios 2.52 and 10.9 times larger, and true costs 75.48 and 20.92 times lower, respectively. A true net income break-even point happened after 19.78 sonographically guided-office-based procedures. Sensitivity analysis showed a threshold between wide-awake and last 25% sonographically guided true costs if the last 25% sonographically guided turnover times reached 65.23 and 27.81 minutes, respectively. However, this trial was underpowered. This trial comparing surgical models was underpowered and is inconclusive on turnover times; however, the sonographically guided-office-based approach showed shorter turnover times and better economic results with a quick recoup of the costs of sonographically assisted surgery.