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Cost Effective Analysis of Simultaneous Versus Staged Bilateral Carpal Tunnel Release
Paul Phillips, MD; James Kennedy, MD; Tara Lee, MPH
Department of Plastic Surgery, University of Tennessee College of Medicine, Chattanooga, TN
Background: As healthcare in the United States continues to find more efficient and cost effective methods of treatment, physicians must evolve modalities and habit. Carpal tunnel syndrome is the most common compressive neuropathy with 56-87% of patients experiencing bilateral symptoms. Simultaneous bilateral carpal tunnel release has been proven to be both safe and effective. Our aim is to conduct a cost analysis of simultaneous versus staged bilateral carpal tunnel release through a retrospective chart review.
Hypothesis: We hypothesize simultaneous bilateral carpal tunnel release is more cost effective and time efficient for both patient and surgeon than staged bilateral carpal tunnel release.
Specific Aims: Analyze the cost of simultaneous bilateral carpal tunnel release and staged bilateral carpal tunnel release by evaluating: patient cost, work time lost, number of follow-up visits required, and physician fees.
Methods: Retrospective review of 198 patients who had bilateral carpal tunnel release performed between August 2009 and March 2014 by a single surgeon. Simultaneous versus staged procedures were compared with respect to billed charges, fees collected, days until return to work (with and without limitations), and the number of post-operative visits.
Results: 19 patients had bilateral carpal tunnel release performed between August 2009 and March 2014 by a single surgeon. Simultaneous versus staged procedures were compared with respect to patient charges, patient amount paid, days until return to work (with and without limitations), and the number of post-operative visits. Mean amount billed and total fees collected were both significantly reduced in the simultaneous versus the staged procedures (\,312.09 vs. \,364.46 and \.87 vs. \,003.43, p<0.05). Days returning to work (with and without limitations) were significantly reduced in the simultaneous procedures relative to the staged procedure (13 and 21 vs. 27 and 45 days respectively, p<0.001). The numbers of post-operative follow up visits were also reduced in the simultaneous procedure when compared to the staged procedure (1.45 vs 3.46 visits, p<0.001).
Conclusions: It is evident simultaneous bilateral carpal tunnel release is more efficient and cost-effective than bilateral staged release. Simultaneous release is beneficial for the patient in terms of work days missed and cost. The surgeon benefits from fewer postoperative office visits are necessary and the remuneration per hour is increased. Overall, simultaneous bilateral carpal tunnel release benefits patients and surgeons in terms of cost-effectiveness and time efficiency when compared to staged release of bilateral carpal tunnel syndrome.
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