Journal of Hand Surgery - June 2022 - S468

S468
Journal of Hand Surgery (Eur) 47(Supplement 1)
schedules; as well as other modalities required for
hand therapy. Estimates of the typical costing of this
kit in South Africa were calculated, along with information
regarding which resources are available on
state tenders to enable therapists to procure these
through their departments where budgets exist.
Conclusion: This practice innovation aims to support
South African occupational therapists in improving
the hand therapy services delivered to patients in
low resource communities. For many patients in
these settings, their hands are their source of
employment and means for interacting with their
world. However, many patients are not able to
access therapy at hospitals, requiring hand therapy
services to be brought to their community. The customisable
prototype offers universal and adaptable
aspects to suit different clients and community
needs and has further potential to be ordered for
use in other settings or replicated in other LMIC
countries using available resources. In pursuit of
the vision of hand therapy being available to all
South Africans, opportunities for the Department of
Health to provide all community therapists with a
hand therapy portable station will be explored.
A-2264 The Direct Cost of Surgery for Cubital
Tunnel Syndrome
Andrew Landau, Christopher J. Dy, Margaret Olsen,
Katelin Nickel, Joanna Buss and David M. Brogan
Washington University in St. Louis, St. Louis, USA
Hypothesis Despite its widespread prevalence, the
economic impact of cubital tunnel syndrome (CuTS)
in the United States is not well understood. The purpose
of this study was to quantify the direct costs
associated with operative treatment of CuTS in
adults to better understand the economic implications
and societal value of surgical treatment. We
hypothesized that CuTS represents a substantial
cost to the patient, similar to the cost of Carpal
Tunnel Syndrome (> $3,000).
Methods: Utilizing the Truven Health Analytics IBM
MarketScan Database of insured patients (commercial
and Medicaid), we identified a cohort of 129,390
patients aged 18 to 64 years (mean¼50 years) with
surgically-treated CuTS from 2006 to 2018, from
which we evaluated the average cost of cubital
tunnel release (CuTR) and/or ulnar nerve transposition
for index admissions associated with CuTR surgery
and all payments toward claims (including
medical, surgical, therapy, and pharmacy claims)
for 90 days after surgery.
Results: Of the 129,390 surgically treated CuTS
patients identified, the mean (standard deviation
[SD]) and median (interquartile range [IQR]) values
of direct payments were $7,062.65 ($13,301.70) and
$4,531 ($2,733, $7,639), respectively. Based on published
estimated surgical rates (>73,673 cases/year)
2-3, this leads to an estimated direct annual cost of
more than $333,812,000 to $520,326,000 in the U.S.
Among direct payments associated with the index
surgery, facility (95.4% outpatient; $5,105.21
[$11,937.13], $2,822[$1,437, $5,410]) and provider
costs ($2,296.93 [$3,567.19], $1,744 [$1,176,
$2,524]) were the most significant, with the surgeon
payment ($948.21 [$462.75], $850 [$614, $1,128])
representing<19% of total index costs. The surgical
procedure payment ($948.21 [854.98], $444 [$300,
$715]) was less substantial. Post-operative care,
including medications, therapy, diagnostics and
treatment of complications had a mean and median
cost of $2,234.48 ($13,099.03) and $113 ($0, $930),
respectively. Summary Points * Direct charges for
the surgical treatment of CuTS from the index surgery
to 90 days post-op have an estimated mean total
of $9,297.13 and median total of $4,644 per patient,
totaling $334 to $520 million annually in the U.S.
* Payments to surgeons represent 18.3% of the overall
direct costs. * Facility fees are responsible for
more than 62.3% of index surgery costs associated
with surgical treatment of cubital tunnel syndrome.
* Defining this surgical cost data is critical to understanding
the economic impact of CuTS, and provide
baseline value to assess the cost-effectiveness
of surgery and other interventions in patients
with CuTS.
A-2265 Antenatal counselling in hand surgery
Gillian Smith
Great Ormond Street Hospital, London, UK
Antenatal counselling in cleft surgery has occurred
for many years. With whole exome sequencing and
better antenatal scanning, together with higher rates
of infertility treatment, there is new demand for
counselling for other conditions including limb
anomalies. This is an area which will be unfamiliar
for most hand surgeons.
Methods: The senior surgeon saw 166 new patients
referred to a specialist congenital hand service in
one year during the coronavirus pandemic. The
number presenting with an antenatal diagnosis and
the number referred for antenatal counselling by the
surgeon were examined.
Results: There were only 4 patients referred antenatally
and 2 more who had had an antenatal diagnosis.
Of the patients referred, two were referred following
whole exome sequencing after limb deformities had
Journal of Hand Surgery - June 2022

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