The hidden cost of training orthopaedic surgery residents to perform an open carpal tunnel release

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Abstract

Background:

Training orthopaedic surgery residents is time consuming and expensive. The objective of the current study was to determine the time and costs associated with teaching orthopaedic residents to perform an open carpal tunnel release (CTR).

Methods:

A retrospective chart review of a single orthopaedic hand surgeon’s outpatient surgical cases over 18 mo was performed. One hundred-six isolated open carpal tunnel releases were identified. Seventy-seven were performed while training orthopaedic surgery residents, and 29 were performed by the attending surgeon alone. Standard demographics, post-graduate year (PGY) of training, and surgical times were abstracted from the charts.

Results:

The time (minutes) required to perform a CTR for PGY-2, 3, and 4 when compared to the attending surgeon was 13.8±3.5 (P=0.012), 16.4±4.9 (P<0.001) and 13.1±4.2 (P=0.044), respectively, with a resident average of 13.7±4.2 min. The attending surgeon required 10.4±4.2 min, which is 3.3 min less than the average resident time (P<0.001). There was no statistically significant difference when comparing surgical times between resident years of training.

Conclusions:

Orthopaedic surgical residents on average required 32% more surgical time to perform an open CTR. Total ambulatory operating room and anesthesia charge was approximately $137/min at our institution with a collection rate of 27% resulting in a per minute cost equal to $37/min. The 77 cases performed while training residents added an additional $34,811.70 in charges with a resultant $9,401.70 in reimbursement.

Level of Evidence:

Level IV, retrospective review.

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