Cost Effectiveness of Hand Postaxial Polydactyly Type B Excision in the Office Versus Operating Room

TL;DR

This study compares the costs and outcomes of removing extra fingers in the office versus the operating room, finding office excision is much cheaper with similar results.

Contribution

The study provides the first detailed cost comparison of office versus operating room excision for postaxial polydactyly type B.

Findings

Office excision had 78% lower charges for bilateral cases and 84% lower for unilateral cases compared to operating room excision.

Insurance reimbursements were $7800 higher for bilateral and $7600 higher for unilateral operating room excisions.

Outcomes were not affected by the treatment setting.

Abstract

Postaxial polydactyly type B of the hand can be excised in the office with local anesthesia or in the operating room under general anesthesia. Existing studies have not described the cost difference between these treatments. We compared charges, reimbursements, and outcomes of office and operating room excision.

All cases of postaxial polydactyly type B excision at a children’s hospital from fiscal year 2018–2023 were included. Independent t tests and Fisher exact tests were performed to compare the charges and outcomes of office and operating room excisions. Random-effects models were used to compare differences in reimbursements since these data were obtained as summary statistics (mean [SD]) by fiscal year.

Of 620 total patients, 30 (4.8%) underwent operating room excisions (22 bilateral and 8 unilateral), and 590 (95%) had office excisions (346 bilateral and 244 unilateral). Average total charges were 78% and 84% less for bilateral and unilateral excisions, respectively, in the office than in the operating room. Insurance companies paid $7800 more for bilateral operating room excisions and $7600 more for unilateral operating room excisions. Surgeons received $2300 more for bilateral operating room excisions and $1300 more for unilateral operating room excisions. The treatment strategy did not impact outcomes.

Given the cost efficacy and safety of office excision, operating room excision should be limited to patient-specific factors requiring general anesthesia.

Prognosis IIb.