General Anesthesia, Hospital Setting Increase Costs of Carpal Tunnel Release

The use of general anesthesia, performing carpal tunnel release (CTR) in a hospital setting, and the use of antibiotics and opioids all increase the procedure-related costs of CTR, according to an analysis of procedures performed at a large, diverse patient population in New York.

Lead author Peter Brodeur, a medical student from The Warren Alpert Medical School of Brown University, and colleagues noted that, given the large number of CTRs performed in the United States each year, the economic impact of lowering procedure-related costs could reach up to $5 billion per year.

Mr. Brodeur and investigators reviewed the New York Statewide Planning and Research Cooperative System database to identify adults with carpal tunnel syndrome (CTS) who underwent CTR between 2016 and 2017.

A total of 10,173 claims were identified. The average charge per claim was $4,780. When the researchers conducted a multivariable analysis to determine factors that increased the total charge of claims, they found that the use of general anesthesia was associated with higher charges than the use of local anesthesia. The location of the surgery also affected costs, with CTRs performed in a hospital outpatient department having approximately 51% higher charges than those performed in an ambulatory surgery center.

Procedures performed using an open approach were 47% lower than those performed with an endoscopic approach. In addition, a one-minute increase in operating time led to a 0.56% increase in total charges. The authors also found that claims with antiemetics, antihistamines, benzodiazepines, intravenous fluids, narcotic agents, or preoperative antibiotics were associated with higher total procedure-related costs versus claims that did not bill for these agents.

Together, these findings suggest that using local anesthesia, performing CTRs in an ambulatory or office setting, and avoid the use of unnecessary medications could reduce overall procedure-related costs, the authors concluded.