A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States.
BACKGROUND
Carpal tunnel surgery (CTS) can be performed in the clinic or operating room with similar outcomes. Our goals were to perform a total cost comparison, profit analysis, and assess efficiency of CTS in each setting.


METHODS
A detailed cost analysis for all CTSs at a tertiary care academic center was done for the year 2007. We calculated the net revenues and profit margins for single endoscopic port and open CTS performed in each setting in the year 2007. For efficiency analysis, we assumed that the time saved by performing a procedure in the more efficient setting could accumulate and permit additional CTSs. This would be the opportunity cost of performing CTS in the less efficient setting.


RESULTS
In general, the operating room was a costlier setting than the clinic. The total cost per case when performing single-port endoscopic CTS was more than double ($2273 vs. $985) when performed in the operating room versus the clinic. For open CTS, the operating room was more than 4 times as expensive than the clinic ($3469 vs. $670). For single endoscopic port cases, profits gained were greater than double in the clinic versus the operating room ($2710 vs. $1139). For open CTS, clinic cases had a profit margin per case of $1186; however, procedures in the operating room incurred a loss of $650 per case. The block time allowed for CTS in the clinic was 30 and 60 minutes in the operating room. To value this efficiency, we used the profit margin of CTS performed in the clinic ($2710) and divided it by the 30 minutes it took to perform. This provided us with a multiplier of $90/min. We multiplied the 30 minutes saved when operating in the clinic by the $90/min to give us an opportunity cost of $2700.


CONCLUSIONS
Performing either single endoscopic port or open CTS in the operating room is more expensive and less efficient than in the clinic setting.
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. abhishek.chatterjee@hitchcock.org
Abhishek
A
Chatterjee
James E
JE
McCarthy
Shirley A
SA
Montagne
Kenneth
K
Leong
Carolyn L
CL
Kerrigan
D000554:Ambulatory Care Facilities / Q000191:economics* / Q000458:organization & administration; D002349:Carpal Tunnel Syndrome / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D009873:Operating Rooms / Q000191:economics* / Q000458:organization & administration; D017063:Outcome Assessment, Health Care / Q000191:economics; D014481:United States