Use and Associated Spending for Anesthesiologist-Administered Services in Minor Hand Surgery.

Area of Science:

• Health Services Research
• Anesthesiology
• Health Economics

Background:

• Evidence is limited regarding the necessity of specialized anesthesia providers for minor surgical procedures in low-risk patients.
• The study addresses the potential for discretionary use of anesthesiologist-administered anesthesia services.

Purpose of the Study:

• To estimate the prevalence and cost of anesthesiologist-administered anesthesia services for low-risk patients undergoing minor hand surgery.
• To analyze trends in the use and cost of these services between 2010 and 2015.

Main Methods:

• Retrospective analysis of claims data from the Truven MarketScan Database (2010-2015).
• Inclusion of minor hand surgeries: carpal tunnel release, trigger finger release, and de Quervain release.
• Utilized a predictive probability model for patient risk stratification and multivariable regression to assess anesthesia use in relation to risk status.

Main Results:

• 80% of 441,579 minor hand surgeries involved anesthesiologist-administered anesthesia.
• Anesthesiologist use in low-risk patients decreased from 69.7% in 2010 to 65.8% in 2015.
• Average payment per procedure increased, with 83.7% of payments ($133 million) attributed to low-risk patients.

Conclusions:

• Anesthesiologist-administered anesthesia is common in low-risk surgical patients, indicating potential for cost savings.
• Current healthcare reforms may not sufficiently address discretionary service use.
• The implications for bundled payment models warrant consideration due to the potentially discretionary use of specialized anesthesia providers.