A Cost Analysis of Carpal Tunnel Procedures Performed in an Office Procedure Room Versus a Hospital Operating Room in a Rural Midwest Health System

<b>Introduction:</b> Carpal tunnel release (CTR) is one of the most common performed hand surgery procedures, yet the estimated yearly cost of carpal tunnel syndrome in the United States is $2 billion, resulting in significant costs to both healthcare systems and patients. Recently, there has been a trend to move minor hand surgery cases from the hospital operating room (OR) to a clinic-based procedure room (PR). This study aimed to examine CTR costs within our institution performed in the PR compared to the OR. <b>Methods:</b> All CTR surgeries performed by three fellowship-trained orthopedic hand surgeons in the OR and PR at a rural health system from 2019-2020 were reviewed. The operative times, number of personnel and supplies required in each clinical location were examined to calculate costs. CTR cost and insurance revenue models were created, and total costs, revenue, and net revenue were compared. <b>Results:</b> A total of 1416 CTRs were performed during the study period, with 855 in the OR and 561 in the PR. The average total cost for CTR in the OR was $2196.10 compared to $549.07 in the PR. The average net revenue of CTR was significantly greater when done in the OR versus PR at $1011.06 and $85.87, respectively. The average reimbursement rate was greater in the OR at 55% compared to 30% for CTRs done in the PR. <b>Conclusion:</b> Overall, the average total cost and net revenue for OR CTR were significantly higher than PR CTR, secondary to higher reimbursement rates in the hospital setting.