Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 5;7(7):e2298.
doi: 10.1097/GOX.0000000000002298. eCollection 2019 Jul.

Metacarpal Fracture Fixation in a Minor Surgery Setting Versus Main Operating Room: A Cost-minimization Analysis

Anna K Steve  1 , Christaan H Schrag  1 , Alice Kuo  2 , A Robertston Harrop  1
Affiliations

Metacarpal Fracture Fixation in a Minor Surgery Setting Versus Main Operating Room: A Cost-minimization Analysis

Anna K Steve et al. Plast Reconstr Surg Glob Open. .

Abstract

The objective of this study was to compare the costs of performing metacarpal fracture fixation in minor surgery (MS) versus the main operating room (OR) at a tertiary care center in Calgary, Alberta, from the institutional perspective.

Methods: Data were extracted from the Operating Room Information System and the Business Advisory System by a financial analyst. All data were based on actual expenses from the 2016-2017 fiscal year (US$). Direct costs included: staffing, supply, day (outpatient) surgery unit, post-anesthesia care unit (PACU), and anesthesia (anesthesiologist and equipment) costs. Surgeon and hardware costs were deemed neutral and excluded from the analysis.

Results: The total cost of metacarpal fixation in MS was $250, compared to $2,226 in the OR, after surgeon and hardware costs were excluded. Staffing costs are a major contributing factor to cost by location ($75 in MS versus $233 in OR), largely attributable to 0.5 nursing staff per room in MS compared to 3 nursing staff per room in the OR. Supply costs (minor tray, $94 versus case cart, $247) are also greater for OR cases. The combined costs for DSU ($465), PACU ($435), and anesthesia ($247) totaled $1,147 and are only incurred for OR cases.

Conclusions: Repair of metacarpal fractures in MS represents a substantial cost-minimization strategy from the institutional perspective. Staffing and supply costs by location and the additional combined costs of DS, PACU, and anesthesia are all contributing factors.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Comparison of the total costs of performing metacarpal fixation in minor surgery to the main operating room (US$). OH indicates hospital overhead.
Fig. 2.
Fig. 2.
An example of field sterility, with 4 sterile towels.
Fig. 3.
Fig. 3.
An example of a patient prepped using full sterility.
See this image and copyright information in PMC

References

    1. Feehan LM, Sheps SB. Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study. J Hand Surg Am. 2006;31:1068–1074. - PubMed
    1. Gillis JA, Williams JG. Cost analysis of percutaneous fixation of hand fractures in the main operating room versus the ambulatory setting. J Plast Reconstr Aesthet Surg. 2017;70:1044–1050. - PubMed
    1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26:908–915. - PubMed
    1. Lalonde D. Wide awake local anaesthesia no tourniquet technique (WALANT). BMC Proc. 2015;9(suppl 3):A81.
    1. Warrender WJ. A cost analysis of carpal tunnel release surgery performed wide awake versus under sedation. Plast Reconstr Surg. 2018;142:1532–1538. - PubMed