PERCUTANEOUS A1 PULLEY RELEASE A CLINICAL STUDY

Hand Surgery ◽  
1999 ◽  
Vol 04 (01) ◽  
pp. 45-50 ◽  
Author(s):  
G. I. Bain ◽  
N. A. Wallwork
Keyword(s):  
Cost Savings ◽  
Outpatient Setting ◽  
Percutaneous Technique ◽  
Intravenous Catheter ◽  
Effective Technique ◽  
Percutaneous Release ◽  
Flexor Tendon Injuries ◽  
Palpable Nodule ◽  
Time Of Presentation ◽  
A1 Pulley

Percutaneous A1 pulley release is being increasingly used as an alternative to open surgical release and injection of local steroids for the treatment of the trigger digit. In 31 cases (26 patients), a percutaneous release was performed with a 14-gauge intravenous catheter needle under local anaesthesia in the outpatient setting. We report a 97% successful release and only one case of incomplete release. There were no digital nerve injuries, flexor tendon injuries, bowstringing or infections. By two months, all the patients had no pain at the operative site, and their preoperative range of motion had returned or improved. The percutaneous release is a safe and effective technique which provides significant cost savings. We recommend the percutaneous technique for typical cases of trigger finger with a palpable nodule and reproducible mechanical triggering. We recommend a steroid injection for patients with tenosynovitis and those who do not have reproducible triggering at the time of presentation. The open technique is reserved for complicated cases such as florid tenosynovitis, locked digit, failed percutaneous release or those involving the thumb.

Sonographically Assisted Percutaneous Release of the A1 Pulley: A New Surgical Technique for Treating Trigger Digit

2006 ◽  
Vol 31 (2) ◽  
pp. 191-199 ◽  
Author(s):  
I. M. JOU ◽  
T. C. CHERN
Keyword(s):  
Cadaver Study ◽  
Safe Zone ◽  
Prospective Clinical Study ◽  
Percutaneous Technique ◽  
Direct Visualization ◽  
Percutaneous Release ◽  
Neurovascular Structures ◽  
A1 Pulley ◽  
New Surgical Technique

This study introduces a sonographically assisted percutaneous technique for releasing trigger digits which provides direct visualization of the release and avoids the risks of incomplete release and injury to adjacent neurovascular structures associated with other percutaneous release techniques. The “safe zone” and an estimate of the size of the A1 pulley were determined in a separate cadaver study. We then used these landmarks in a prospective clinical study of 107 digits in 83 consecutive patients treated by this technique. During the follow-ups of between 9 and 15 months, we evaluated 104 digits in 80 patients. Pain was absent in 101 digits (97%) and considerably improved in the other three (3%). All mechanical problems had been resolved and none recurred during follow-up. This technique allows the surgeon to see and monitor, precisely, the percutaneous division of the A1 pulley without open surgery and, therefore, to avoid the inherent risks of percutaneous and open surgical release.

A1 Pulley Release of Locked Trigger Digit by Percutaneous Technique

2004 ◽  
Vol 29 (5) ◽  
pp. 502-505 ◽  
Author(s):  
M. J. PARK ◽  
I. OH ◽  
K. I. HA
Keyword(s):  
Physical Therapy ◽  
Surgical Procedure ◽  
Percutaneous Technique ◽  
Office Setting ◽  
Neurovascular Injury ◽  
Percutaneous Release ◽  
Open Surgical Procedure ◽  
A1 Pulley

We performed 118 percutaneous releases of the locked trigger digits in an office setting using a specially designed knife. Thirty-five digits were locked in flexion, 79 digits in extension and the remaining four were fixed in a semiflexed position. Successful percutaneous release was achieved for 107 digits (91%), with the remaining 11 digits requiring an open surgical procedure. Although there were no persistent triggering in 98 digits with a follow-up of at least 6 months, painful stiffness at the interphalangeal joints remained in ten digits despite of physical therapy. No neurovascular injury occurred. We suggest that a locked trigger digit can be successfully released with the percutaneous technique.

scholarly journals Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S328-S328
Author(s):  
Pushpalatha Bangalore Lingegowda ◽  
Say-Tat Ooi ◽  
Jyoti Somani ◽  
Chelsea Law ◽  
Boon Kiak Yeo
Keyword(s):  
Infectious Diseases ◽  
Diabetic Foot ◽  
Wound Care ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Multidisciplinary Teams ◽  
Diabetic Patients ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

scholarly journals Recoup From Home? Comparison of Relative Cost Savings for ACDF, Lumbar Discectomy, and Short Segment Fusion Performed in the Inpatient Versus Outpatient Setting

2021 ◽  
Vol 11 (1_suppl) ◽  
pp. 56S-65S
Author(s):  
Christopher M. Mikhail ◽  
Murray Echt ◽  
Stephen R. Selverian ◽  
Samuel K. Cho
Keyword(s):  
Minimally Invasive ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Lumbar Discectomy ◽  
Minimally Invasive Techniques ◽  
Relative Cost ◽  
Short Segment ◽  
Lumbar Microdiscectomy ◽  
Same Day Discharge ◽  
Invasive Techniques

Study Design: Broad narrative review. Objective: To review and summarize the current literature on the cost efficacy of performing ACDF, lumbar discectomy and short segment fusions of the lumbar spine performed in the outpatient setting. Methods: A thorough review of peer- reviewed literature was performed on the relative cost-savings, as well as guidelines, outcomes, and indications for successfully implementing outpatient protocols for routine spine procedures. Results: Primary elective 1-2 level ACDF can be safely performed in most patient populations with a higher patient satisfaction rate and no significant difference in 90-day reoperations and readmission rates, and a savings of 4000 to 41 305 USD per case. Lumbar discectomy performed through minimally invasive techniques has decreased recovery times with similar patient outcomes to open procedures. Performing lumbar microdiscectomy in the outpatient setting is safe, cheaper by as much as 12 934 USD per case and has better or equivalent outcomes to their inpatient counterparts. Unlike ACDF and lumbar microdiscectomy, short segment fusions are rarely performed in ASCs. However, with the advent of minimally invasive techniques paired with improved pain control, same-day discharge after lumbar fusion has limited clinical data but appears to have potential cost-savings up to 65-70% by reducing admissions. Conclusion: Performing ACDF, lumbar discectomy and short segment fusions in the outpatient setting is a safe and effective way of reducing cost in select patient populations.

Clinical and Cost Comparison Evaluation of Inpatient Versus Outpatient Administration of EPOCH-Containing Regimens in Non-Hodgkin Lymphoma

2016 ◽  
Vol 30 (4) ◽  
pp. 400-405 ◽  
Author(s):  
Sarah S. Evans ◽  
Arpita S. Gandhi ◽  
Amber B. Clemmons ◽  
David L. DeRemer
Keyword(s):  
Chart Review ◽  
Hospital Admissions ◽  
Antiviral Agents ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Cost Comparison ◽  
Non Hodgkin Lymphoma ◽  
Institutional Review ◽  
Stimulating Factor

Background: Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in non-Hodgkin’s lymphoma, however, the incidence of febrile neutropenia (FN) in patients receiving inpatient versus outpatient EPOCH has not been described. Additionally, no comparisons have been made regarding financial implications of EPOCH administration in either setting. This study’s primary objective was to compare hospital admissions for FN in patients receiving inpatient or outpatient EPOCH. Methods: A single-center, institutional review board-approved review was conducted for adults receiving EPOCH beginning January 2010. Clinical and financial data were collected through chart review and the institution’s financial department. Descriptive statistics were utilized for analysis. Results: A total of 25 patients received 86 cycles of an EPOCH-containing regimen (61 [70.9%] inpatient). Five (8.2%) inpatient cycles resulted in an admission for FN compared to 4 (16%) outpatient cycles. Prophylactic antifungal and antiviral agents were prescribed more often after inpatient cycles (>80%) compared to outpatient cycles (<50%). Overall, 27 (31.4%) of 86 cycles did not receive granulocyte colony-stimulating factor support. Outpatient EPOCH administration was associated with a cost savings of approximately US$141 116 for both chemotherapy costs and hospital day avoidance. Conclusion: EPOCH-containing regimens can be safely administered in the outpatient setting, which may result in cost savings for healthcare institutions.

Safety and feasibility of outpatient high-dose cytarabine (HIDAC) and intermediate-dose cytarabine (IDAC) for consolidation therapy in acute myeloid leukemia (AML).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Wenhui Li ◽  
Katherine Simondsen ◽  
Jamie Lee ◽  
Maher Elharake ◽  
Timothy Edward Kubal
Keyword(s):  
Acute Myeloid Leukemia ◽  
Risk Stratification ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Cost Savings ◽  
Outpatient Setting ◽  
High Dose ◽  
Inpatient Setting ◽  
Consolidation Therapy ◽  
Acute Myeloid

e18509 Background: Patients with acute myeloid leukemia (AML) who achieve complete remission with induction therapy require consolidation therapy. The standard of care consolidation is HIDAC or IDAC depending on age and risk stratification. Consolidation therapy has historically been administered in the inpatient setting. The rising cost of AML care has prompted institutions to consider shifting therapy to the outpatient setting. However, the safety and feasibility of outpatient HIDAC/IDAC consolidation therapy has not been established. Moffitt Cancer Center (MCC) developed an Inpatient/Outpatient (IPOP) program to facilitate administration of complicated regimens in the outpatient setting. We hypothesized that IPOP administration of HIDAC/IDAC consolidation therapy is safe and may have cost-savings implications. Methods: We conducted a retrospective chart review on AML patients who were 18 years or older and received HIDAC/IDAC consolidation therapy at MCC following induction therapy from January 1, 2015 to November 1, 2018. Data collected included age, risk stratification, treatment history, clinic visits, number of cycles received in the IPOP versus inpatient setting, supportive care, hospitalizations, and chemotherapy related adverse events. Results: 258 of 270 cycles of HIDAC/IDAC were delivered outpatient over the reviewed time period to 122 patients. 45 patients (37%) required hospitalization during consolidation with the primary reason being neutropenic fever (72%), consistent with historical data (50 to 90%). No patients receiving outpatient consolidation required hospitalization during chemotherapy. Specific details regarding administration of HIDAC/IDAC in IPOP, including infusion times, frequency of visits, laboratory frequency, supportive medications, and home antimicrobials will be reported. 1,290 hospital days were saved through IPOP administration. Financial assessment of cost-savings is being determined and will be reported. Conclusions: Outpatient administration of HIDAC/IDAC consolidation therapy for AML is a safe option for AML patients undergoing consolidation.

Is Outpatient Laparoscopic Cholecystectomy Safe and Cost-effective?

1999 ◽  
Vol 90 (6) ◽  
pp. 1746-1755. ◽  
Author(s):  
Lee A. Fleisher ◽  
Kelvin Yee ◽  
Keith D Lillemoe ◽  
Mark A. Talamini ◽  
Charles J. Yeo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Outpatient Surgery ◽  
Operating Time ◽  
Cost Savings ◽  
Postoperative Nausea And Vomiting ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Postanesthesia Care Unit ◽  
Outpatient Basis ◽  
Home Setting

Background There is increasing pressure to perform traditional inpatient surgical procedures in an outpatient setting. The aim of the current trial was to determine the safety and cost savings of performing laparoscopic cholecystectomy in an outpatient setting using a "mock" outpatient setting. Methods Patients who were scheduled for laparoscopic cholecystectomy by four attending surgeons and for whom operating time was available in the outpatient center were studied. All patients received a standardized anesthetic, including ondansetron, and were discharged from the outpatient postanesthesia care unit if appropriate. At discharge, all patients were admitted to a clinical research center where they were observed in a "mock home" setting and monitored for complications that would have necessitated readmission. A decision analysis was created assuming all patients underwent outpatient surgery with either direct admission or discharge to home and readmission if complications developed. Results Of 99 patients who were enrolled in this study, 96 patients would have met the discharge criteria for home. No major complications were observed in these 96 patients. Eleven patients experienced postoperative nausea and vomiting, 3 of whom required an additional 24 h of hospital observation. In the decision model, the optimal strategy would be to perform the procedure on an outpatient basis and readmit patients only for complications, with an average baseline cost savings of $742/patient. Conclusions The results show that outpatient laparoscopic cholecystectomy is safe and cost-effective in selected patients, and that the mock home setting provides a means of studying the safety of transition of care.

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