title: The Effect of Moving Carpal Tunnel Releases Out of Hospitals on Reducing United States Health Care Charges.
abstract: OBJECTIVE
  To better understand how perioperative care affects charges for carpal tunnel release (CTR).
  
  
  METHODS
  We developed a cohort using ICD9-CM procedure code 04.43 for CTR in the National Survey of Ambulatory Surgery 2006 to test perioperative factors potentially associated with CTR costs. We examined factors that might affect costs, including patient characteristics, payer, surgical time, setting (hospital outpatient department vs. freestanding ambulatory surgery center), anesthesia type, anesthesia provider, discharge status, and adverse events. Records were grouped by facility to reduce the impact of surgeon and patient heterogeneity. Facilities were divided into quintiles based on average total facility charges per CTR. This division allowed comparison of factors associated with the lowest and highest quintile of facilities based on average charge per CTR.
  
  
  RESULTS
  A total of 160,000 CTRs were performed in 2006. Nearly all patients were discharged home without adverse events. Mean charge across facilities was $2,572 (SD, $2,331-$2,813). Patient complexity and intraoperative duration of surgery was similar across quintiles (approximately 13 min). Anesthesia techniques were not significantly associated with patient complexity, charges, and total perioperative time. Hospital outpatient department setting was strongly associated with total charges, with $500 higher charge per CTR. Half of all CTRs were performed in hospital outpatient departments. Facilities in the lowest quintile charge group were freestanding ambulatory surgery centers.
  
  
  CONCLUSIONS
  Examination of charges for CTR suggests that surgical setting is a large cost driver with the potential opportunity to lower charges for CTRs by approximately 30% if performed in ASCs.
  
  
  METHODS
  Economic/decision analysis II.
authors.affiliation: Stanford University School of Medicine, Stanford, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA.
authors.forename: Christine
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Milstein
authors.affiliation: Division of General Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.affiliation: Department of Surgery, Palo Alto Veterans Administration, Palo Alto, CA; Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA. Electronic address: curtincatherine@yahoo.com.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Curtin
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D002349:Carpal Tunnel Syndrome / Q000191:economics / Q000601:surgery*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005249:Fees and Charges; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States
keywords: Carpal tunnel release; charge reduction; health care innovation