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Sonographically Guided Intrasheath Percutaneous Release of the First Annular Pulley for Trigger Digits, Part 2
Author(s) -
Rojo-Manaute Jose Manuel,
Capa-Grasa Alberto,
Cerro-Gutiérrez Miguel Del,
Martínez Manuel Villanueva,
Chana-Rodríguez Francisco,
Martín Javier Vaquero
Publication year - 2012
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/jum.2012.31.3.427
Subject(s) - medicine , ambulatory , percutaneous , surgery , revenue , accounting , business
Objectives 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 Results Thirteen sonographically guided–office‐based patients were withdrawn because of a learning curve influence.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.