title: 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.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  Thirteen sonographically guided-office-based patients were withdrawn because of a learning curve influence.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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007 Madrid, Spain. k2rojo@yahoo.com
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Rojo-Manaute
authors.forename: Alberto
authors.initials: A
authors.lastname: Capa-Grasa
authors.forename: Miguel
authors.initials: M
authors.lastname: Del Cerro-Gutiérrez
authors.forename: Manuel Villanueva
authors.initials: MV
authors.lastname: Martínez
authors.forename: Francisco
authors.initials: F
authors.lastname: Chana-Rodríguez
authors.forename: Javier Vaquero
authors.initials: JV
authors.lastname: Martín
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000379:methods*; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000000981:diagnostic imaging* / Q000601:surgery*; D018084:Ultrasonography, Interventional / Q000379:methods*