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

Area of Science:

• Hand surgery
• Pediatric surgery
• Congenital anomalies

Background:

• Postaxial polydactyly type B is a common congenital hand anomaly.
• Treatment options include office-based excision under local anesthesia or operating room excision under general anesthesia.
• Limited data exists on the comparative cost-effectiveness of these treatment settings.

Purpose of the Study:

• To compare the charges, reimbursements, and outcomes of office versus operating room excision for postaxial polydactyly type B.
• To evaluate the cost efficacy of different treatment modalities for this condition.

Main Methods:

• Retrospective review of 620 postaxial polydactyly type B excisions at a children's hospital (FY 2018-2023).
• Comparison of charges and outcomes using independent t-tests and Fisher exact tests.
• Analysis of reimbursements using random-effects models.

Main Results:

• Office excisions were significantly less costly: 78% (bilateral) and 84% (unilateral) reduction in charges compared to operating room excisions.
• Higher reimbursements for operating room excisions by insurance companies ($7800 bilateral, $7600 unilateral).
• Surgeons received higher payments for operating room excisions ($2300 bilateral, $1300 unilateral), with no difference in patient outcomes.

Conclusions:

• Office excision of postaxial polydactyly type B is a cost-effective and safe treatment option.
• Operating room excision should be reserved for cases with specific patient factors necessitating general anesthesia.