Journal of Hand Surgery - June 2022 - S506

S506
Journal of Hand Surgery (Eur) 47(Supplement 1)
decreased time overall allocated by personnel. The
monitoring performed by the pre-op RN was one of
the longest steps at each facility. At the hospital, this
step on average took 96.75 minutes, while it took only
92.3 minutes at the ASC (Table 1). The greatest difference
in timing was PACU monitoring; the hospital
averaged 101.4 minutes while the ASC only took 60.8
minutes (Table 1). These differences allowed for an
overall reduction of the direct variable cost attributed
to the per-minute salaries of personnel.
Conclusion: * ASCs are only 6% more cost effective
than hospital ORs for CTR procedures. * The largest
contributor to the cost reduction at ASCs was direct
variable cost; this can be attributed to the decrease
in time required most steps by personnel at the ASC.
* Direct fixed costs were the largest contributor to
the overall cost of procedures and did not vary
between the OR and ASC; this could be an avenue
for future research in cost reduction.
A-2406 Do Ambulatory Surgical Centers Save
Money? An Analysis of Concomitant Surgical Costs
Using Time Drive Activity-Based Costing Methods
Jessi Fore, Alex Lindahl, Jacob Kalkman and
Charles S. Day
Henry Ford Health System
Introduction: Ambulatory surgery centers (ASCs) are
often used for outpatient surgical procedures in
place of hospital operating rooms (ORs). We hypothesize
that the additional cost of concomitant carpal
tunnel release (CTR) and trigger finger release (TFR)
procedure will be reduced in an ASC.
Materials and Methods: Separate process maps,
including all steps of patient care from arrival to discharge,
were constructed using combined CTR with
TFR procedures in both ASC and OR settings. The
time needed to complete each step of the process
map was measured for all patients and used to calculate
cost according to the Time-Driven ActivityBased
Costing (TDABC) methodology. Total costs
were broken down for comparison in the following
categories: * Direct Variable Costs: Associated with
individual salaries for staff involved in patient care. *
Direct Fixed Costs: Associated with building fees and
materials. * Indirect Costs: Not directly linked to the
procedure (e.g. marketing, administration, and
maintenance).
Results: The total cost for combined CTR with TFR in
an OR was $3,346. Within this total, direct fixed,
direct variable, and indirect costs were $1,634.38
(48.8% of cost), $755.62 (22.6%), and $956 (28.6%),
respectively. In the ASC setting, the total cost was
reduced to $3,216.78, $129.22 less than the OR cost.
This total was broken down to $1,634.38 direct fixed
(50.8%), $663.32 direct variable (20.6%), and $919.08
indirect cost (28.6%). There was no difference
between direct fixed costs at the OR versus the
ASC; however, there was a $92.30 reduction in
direct variable costs and a $36.92 reduction in indirect
costs. When comparing time on each step, the
ASC showed decreased time overall allocated by personnel
thus allowing for an overall reduction of the
direct variable cost attributed to the per-minute salaries
of personnel (Table 1).
Conclusion: * ASCs are only 4% more cost effective
than ORs for concomitant CTR and TFR procedures.
* The largest contributor to the cost reduction at
ASCs was direct variable cost; this can be attributed
to the decrease in time required by most personnel
at the ASC. * Direct fixed costs were the largest contributor
to the overall cost of procedures and did not
vary between the OR and ASC; this could be an
avenue for future research in cost reduction.
A-2407 Preliminary results of lignocaine levels in
the blood during distal end radius plating under
WALANT
Shalimar Abdullah, Muhd Fitri Tokiman, Amir Ahmad,
Lim Chia Hua and Fauziana Jabbar
Department of Orthopaedics, Hospital UKM, Universiti
Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
Lignocaine has been proven safe during dental surgeries
and small procedures. With the introduction of
bony WALANT (Wide awake local anaesthesia no
tourniquet), larger amounts of lignocaine are
injected to achieve anaesthetic effects. We studied
the levels of lignocaine in blood during the injection
of WALANT during distal end radius plating and at 5
minutes, 10 minutes, 30 minutes, 60 minutes and 6
hours. There were two groups: a control group
receiving pure 2% lignocaine injected after distal
radius plating under GA and the study group, 10
patients undergoing WALANT of plating of distal
end radius receiving 40 ml of 1% lignocaine with
adrenaline 1: 100,000. We found that the levels of
lignocaine was highest at 5 mins: Control group
(mean¼2.999 ug/ml), Study group (mean¼3.802
ug/ml) and thereafter rapidly declined. These levels
were very much below the level of mild lignocaine
toxicity of 6 ug/ml and cardiotoxicity of 8 ug/ml.
Journal of Hand Surgery - June 2022

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