Synergistic Surgical Strategies: A Comparative Analysis of Combined Carpal Tunnel and Trigger Finger Release

Introduction: Since 1980, U.S. healthcare spending has outpaced GDP growth, while lagging outcomes, highlighting the need to evaluate cost-effectiveness of treating Trigger Finger Release (TFR) and Carpal Tunnel Release (CTR) simultaneously or sequentially. Methods: 36 Patients were recruited: 12 CTR and 12 TFR patients comprised the sequential cohort, while 12 patients who underwent simultaneous CTR and TFR comprised the simultaneous cohort. Costs were calculated utilizing time-dependent activity-based costing (TDABC), activity-based costing (ABC), and insurance claims data. Procedural times were tracked and multiplied by personnel per-minute salaries to determine direct variable labor costs. Direct variable costs for supplies and direct fixed costs came from insurance claims data. Indirect costs were calculated as 40% of all other costs. Patient outcomes were measured by differences in pre-operative and 3-month post-operative Patient-Reported Outcome Measures Information System (PROMIS) scores for Upper Extremity (UE), then multiplied by average life-years remaining, to calculate PROMIS-adjusted life-years (PALY). Dividing costs by PALYUE yielded respective average cost-effectiveness ratios (ACER). For the sequential cohort, methods were performed separately for each procedure, then averaged and summed. Results: The average cost was $8,555 for sequential and $6,139.73 for simultaneous CTR and TFR (p = .001). No significant difference was observed between sequential and simultaneous PROMISUE (4.21 vs 1.92, p=0.353). Simultaneous ACERUE ($12,319.85) was greater than sequential ACERUE ($7,819.61). Conclusion: Simultaneous CTR and TFR had significantly lower total costs. However, considering both total costs and patient outcomes (PALYUE) using ACER, sequential ACERUE was lower than simultaneous, indicating higher value for sequential CTR and TFR.