Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings

Abstract

Importance: Surgical procedures can be performed in different settings, but the association between the operative setting and patient safety and cost to the patient and payer is unknown. Objective: To examine differences in complications, total payments, and out-of-pocket (OOP) spending for minor hand surgical procedures performed in office, ambulatory surgery center (ASC), and hospital outpatient department (HOPD) operative settings. Design, Setting, and Participants: A retrospective, population-based cohort study was conducted using deidentified claims data from private employer-sponsored health insurance from January 1, 2009, to December 31, 2017. Patients aged 18 years or older undergoing carpal tunnel release, trigger finger release, excision of wrist ganglion, and excision of small hand masses (N = 468365) were included. Exposures: Operative setting, defined as procedures performed in the clinic setting, ASC, and HOPD. Main Outcomes and Measures: Complications during the 90-day postoperative period, total payments (total facility and payer reimbursement), and OOP spending. Results: Of the 468365 patients, 296378 women (63.3%) and 171987 men (36.7%) underwent minor hand surgical procedures from 2009 to 2017, with 284889 procedures (60.8%) performed in HOPDs, 158659 procedures (33.9%) performed in ASCs, and 24817 procedures (5.3%) performed in the office setting. Ninety-day complications occurred in 3.4% of procedures performed in HOPDs, 3.3% in ASCs, and 2.9% in office settings (P