Karpal Tünel Sendromu Cerrahi Tedavisinde Uygulanan Lokal Anestezi veya Periferik Sinir Bloğunun Postoperatif Komplikasyonlara Etkisi ve Maliyet Analizi
Abstract
Amaç:Karpal tünel sendromu cerrahisi en sık uygulanan el cerrahisi ameliyatlarından birisidir ve artmış sağlık harcamalarına neden olmaktadır. Çalışmanın amacı, lokal veyaperiferik sinir bloğu yöntemleriyle uygulanan açık karpal tünel sendromu cerrahilerinin postoperatif komplikasyonlara ve ameliyat maliyetlerine etkilerinin incelenmesidir.
Gereç ve Yöntem:Ocak 2013 ile Aralık 2018 tarihleri arasında, 323 hastanın 382 eline uygulanan lokal veyaperiferik sinir bloğu ile açık karpal tünel cerrahilerine bağlı gelişen postoperatif komplikasyonlar ve ameliyat maliyetleri açısından retrospektif olarak incelenmiştir.Hasta kayıt sisteminden; en az 12 aylık takibi olan hastaların yaş, cinsiyet, ameliyat tarihi, anestezi tipi, eşlik eden hastalıkları, postoperatif komplikasyonları, komplikasyon tarihleri, toplam yatış süreleri, toplam takip süreleri ve toplam cerrahi maliyetleri incelenmiştir.
Bulgular: Lokal anestezi uygulanan hastalarda ortalama ameliyat maliyeti istatistiksel olarak anlamlı düzeyde daha düşük bulunmuştur(p<0.001). Periferik sinir bloğu uygulanan hastalarda istatistiksel olarak anlamlı düzeyde artmış hastane yatış süreleri gözlendi(p=0.005). Lokal anestezi grubunda 2 hastada postoperatif 4. ve 6. yıllarda revizyon cerrahisi uygulanmış olup anestezi tipi ile komplikasyonlar arasında ilişki bulunamamıştır (p=0.554).
Sonuç:Lokal anestezi, karpal tünel sendromu açık cerrahi tedavisinde kullanılabilen, düşük komplikasyon oranlarına sahip, güvenilir ve maliyet-etkin bir yöntemdir. Günübirlik cerrahi şeklinde uygulanabilir olması, hastane yatışı ve ameliyat öncesi hazırlık gerektirmemesi ve genel anestezi ilişkili komplikasyonlara yol açmaması nedeniyle artan sağlık harcamalarının önlenebileceği bir uygulamadır.
References
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Abstract
References
- 1. Lorgelly PK, Dias JJ, Bradley MJ, Burke FD. Carpal tunnel syndrome, the search for a cost-effective surgical intervention: a randomised controlled trial. Annals of the Royal College of Surgeons of England. 2005;87(1):36.
- 2. Foster BD, Sivasundaram L, Heckmann N, Cohen JR, Pannell WC, Wang JC, et al. Surgical approach and anesthetic modality for carpal tunnel release: a nationwide database study with health care cost implications. Hand. 2017;12(2):162-7.
- 3. Ingram J, Mauck BM, Thompson NB, Calandruccio JH. Cost, value, and patient satisfaction in carpal tunnel surgery. Orthopedic Clinics. 2018;49(4):503-7.
- 4. Schuh A, Schuh R. Erfahrungen aus 925 ambulant durchgeführten Operationen des Karpaltunnelsyndroms. Zentralblatt für Chirurgie. 2002;127(03):224-7.
- 5. Tomaino M, Ulizio D, Vogt M. Carpal tunnel release under intravenous regional or local infiltration anaesthesia. The Journal of Hand Surgery: British & European Volume. 2001;26(1):67-8.
- 6. Patil S, Ramakrishnan M, Stothard J. Local anaesthesia for carpal tunnel decompression: a comparison of two techniques. Journal of Hand Surgery. 2006;31(6):683-6.
- 7. Tulipan JE, Kim N, Abboudi J, Jones C, Liss F, Kirkpatrick W, et al. Open carpal tunnel release outcomes: performed wide awake versus with sedation. Journal of hand and microsurgery. 2017;9(02):074-9.
- 8. Alter TH, Warrender WJ, Liss FE, Ilyas AM. A cost analysis of carpal tunnel release surgery performed wide awake versus under sedation. Plastic and reconstructive surgery. 2018;142(6):1532-8.
- 9. Cozowicz C, Poeran J, Zubizarreta N, Mazumdar M, Memtsoudis SG. Trends in the use of regional anesthesia: neuraxial and peripheral nerve blocks. Regional Anesthesia & Pain Medicine. 2016;41(1):43-9.
- 10. Voskeridjian AC, Calem D, Rivlin M, Beredjiklian PK, Wang ML. An Evaluation of Complications Following Ultrasound-Guided Regional Block Anesthesia in Outpatient Hand Surgery. HAND. 2019:1558944719851207.
- 11. White M, Parikh HR, Wise KL, Vang S, Ward CM, Cunningham BP. Cost Savings of Carpal Tunnel Release Performed In-Clinic Compared to an Ambulatory Surgery Center: Time-Driven Activity-Based-Costing. HAND. 2019:1558944719890040.
- 12. Kazmers NH, Presson AP, Xu Y, Howenstein A, Tyser AR. Cost implications of varying the surgical technique, surgical setting, and anesthesia type for carpal tunnel release surgery. The Journal of hand surgery. 2018;43(11):971-7. e1.
- 13. Carr LW, Morrow B, Michelotti B, Hauck RM. Direct cost comparison of open carpal tunnel release in different venues. HAND. 2019;14(4):462-5.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original research article |
| Authors | |
| Publication Date | April 27, 2021 |
| Submission Date | August 25, 2020 |
| Published in Issue | Year 2021 Volume: 54 Issue: 1 |
