How does the cost of open ganglion cyst excision compare to arthroscopic removal. What factors influence the total expenses for ganglion cyst surgery. Which procedure is more cost-effective for treating wrist ganglion cysts.

Understanding Ganglion Cysts and Treatment Options

Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of wrists or hands. These fluid-filled sacs can cause pain, weakness, or interfere with joint movement. While some ganglion cysts may resolve on their own, many require surgical removal, especially if they cause persistent symptoms or affect daily activities.

There are two main surgical approaches for removing ganglion cysts:

• Open excision: A traditional open surgery where an incision is made to remove the cyst
• Arthroscopic excision: A minimally invasive procedure using small incisions and a tiny camera

Both methods aim to remove the cyst and its stalk to prevent recurrence. But how do these procedures compare in terms of cost? A 2017 study published in the Journal of Hand Surgery aimed to answer this question through a cost minimization analysis.

Methodology of the Cost Analysis Study

The researchers conducted a comprehensive cost analysis using data from a private payer administrative claims database. This database included information on 16 million individuals from 2007 to 2015, providing a robust dataset for analysis.

Key aspects of the study methodology included:

• Identification of procedures using Current Procedural Terminology (CPT) codes
• Extraction of demographic data for patients undergoing ganglion cyst excision
• Analysis of fees paid to healthcare providers and facilities for each procedure
• Comparison of costs between open and arthroscopic excision methods

By focusing on the direct costs from the payer’s perspective, the study aimed to determine which procedure was more cost-effective, assuming equivalent clinical outcomes.

Cost Comparison: Open vs. Arthroscopic Ganglion Cyst Excision

The study revealed significant differences in the costs associated with open and arthroscopic ganglion cyst excision:

• Open excision average cost: $1,821
• Arthroscopic excision average cost: $3,668

This represents a substantial cost difference of $1,847 between the two procedures. Arthroscopic excision was found to be approximately twice as expensive as open excision from the payer’s perspective.

Why is arthroscopic excision more expensive? Several factors contribute to the higher cost:

1. Specialized equipment: Arthroscopic procedures require advanced cameras and instruments
2. Longer operating time: Minimally invasive techniques often take more time to perform
3. Additional training: Surgeons need specialized training for arthroscopic procedures
4. Facility fees: Operating rooms equipped for arthroscopic surgery may charge higher fees

Breakdown of Cost Components

To better understand the cost difference, the study broke down the expenses into various components:

Open Excision Costs:

• Surgeon fees: $540
• Facility fees: $1,281

Arthroscopic Excision Costs:

• Surgeon fees: $637
• Facility fees: $3,031

The most significant difference lies in the facility fees, with arthroscopic procedures costing substantially more. This highlights the impact of specialized equipment and operating room requirements on overall costs.

Factors Influencing Cost Variations

While the study provides valuable insights into the average costs, it’s important to note that individual cases may vary. Several factors can influence the total cost of ganglion cyst removal:

• Geographic location: Healthcare costs can vary significantly by region
• Insurance coverage: Different insurance plans may cover varying portions of the procedure
• Surgeon experience: More experienced surgeons may charge higher fees
• Facility type: Hospital-based procedures often cost more than those performed in outpatient centers
• Complications: Any post-operative complications can increase overall costs

Patients should discuss these factors with their healthcare providers and insurance companies to get a more accurate estimate of their out-of-pocket expenses.

Clinical Considerations Beyond Cost

While cost is an important factor, it’s crucial to consider clinical outcomes and patient preferences when choosing between open and arthroscopic ganglion cyst excision. Some potential advantages of arthroscopic procedures include:

• Smaller incisions and less scarring
• Potentially faster recovery time
• Reduced risk of certain complications
• Better visualization of the joint for complex cases

These benefits may justify the higher cost for some patients, particularly those with complex presentations or concerns about scarring. Surgeons should discuss both options with patients, considering individual circumstances and preferences.

Implications for Healthcare Decision-Making

The significant cost difference between open and arthroscopic ganglion cyst excision has important implications for various stakeholders in the healthcare system:

For Patients:

• Higher out-of-pocket expenses for arthroscopic procedures
• Need to weigh potential benefits against additional costs
• Importance of discussing cost implications with healthcare providers and insurers

For Healthcare Providers:

• Consideration of cost-effectiveness in treatment recommendations
• Need for clear communication about cost differences to patients
• Potential for developing more cost-effective arthroscopic techniques

For Payers and Policy Makers:

• Evaluation of reimbursement rates for different procedures
• Potential for implementing value-based payment models
• Need for further research on long-term outcomes and cost-effectiveness

As healthcare costs continue to rise, studies like this play a crucial role in informing decision-making at all levels of the healthcare system.

Future Research Directions

While this cost minimization analysis provides valuable insights, several areas warrant further investigation:

• Long-term outcomes: Do arthroscopic procedures result in fewer recurrences or complications?
• Patient-reported outcomes: How do patients perceive the value and satisfaction of each procedure?
• Indirect costs: What are the differences in time off work and productivity loss between the two methods?
• Cost-effectiveness analysis: Considering both costs and outcomes, which procedure provides better value?
• Technological advancements: How might future innovations affect the cost landscape for ganglion cyst treatment?

Addressing these questions through rigorous research will provide a more comprehensive understanding of the true value proposition for each surgical approach.

Conclusion and Recommendations

The cost minimization analysis of ganglion cyst excision reveals a substantial difference in direct costs between open and arthroscopic procedures. Open excision, with an average cost of $1,821, appears to be the more cost-effective option compared to arthroscopic excision at $3,668.

However, cost should not be the sole determining factor in treatment decisions. Healthcare providers should consider:

1. Individual patient characteristics and preferences
2. Complexity of the case and potential for complications
3. Long-term outcomes and recurrence rates
4. Available resources and surgeon expertise

Patients should be fully informed about both the clinical and financial aspects of their treatment options. Open communication between patients, providers, and payers is essential to ensure that decisions align with both medical best practices and individual circumstances.

As the healthcare landscape continues to evolve, ongoing research and analysis of both costs and outcomes will be crucial in optimizing the value of care for patients with ganglion cysts. By balancing clinical efficacy, patient satisfaction, and economic considerations, stakeholders can work towards more cost-effective and patient-centered treatment approaches for this common condition.

Cost Minimization Analysis of Ganglion Cyst Excision

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Elsevier Science

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. 2017 Sep;42(9):750.e1-750.e4.

doi: 10.1016/j.jhsa.2017.05.012.

Epub 2017 Jun 10.

Eric Quan Pang 
¹
, Steven Zhang 
¹
, Alex H S Harris 
²
, Robin N Kamal 
³

Affiliations

Affiliations

• ¹ Department of Orthopaedic Surgery, Stanford University, Stanford, CA.
• ² Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
• ³ Orthopaedic Surgery-North Campus, Stanford University, Redwood City, CA. Electronic address: rnkamal@stanford. edu.

• PMID:

  28606435

• DOI:

  10.1016/j.jhsa.2017.05.012

Eric Quan Pang et al.

J Hand Surg Am.

2017 Sep.

. 2017 Sep;42(9):750.e1-750.e4.

doi: 10.1016/j.jhsa.2017.05.012.

Epub 2017 Jun 10.

Authors

Eric Quan Pang 
¹
, Steven Zhang 
¹
, Alex H S Harris 
²
, Robin N Kamal 
³

Affiliations

• ¹ Department of Orthopaedic Surgery, Stanford University, Stanford, CA.
• ² Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
• ³ Orthopaedic Surgery-North Campus, Stanford University, Redwood City, CA. Electronic address: [email protected].

• PMID:

  28606435

• DOI:

  10.1016/j.jhsa.2017.05.012

Abstract

Purpose:

Cost minimization analysis can be employed to determine the least costly option when multiple treatments lead to equivalent outcomes. We present a cost minimization analysis from the payers’ perspective, of the direct per patient cost of arthroscopic versus open ganglion cyst excision. We tested the null hypothesis that there is no difference in cost between the 2 procedures from the payer perspective.

Methods:

We utilized data from a private payer administrative claims database comprising 16 million individuals from 2007 to 2015. Using Current Procedural Terminology codes to identify open and arthroscopic ganglion excisions, we extracted demographic data and fees paid to providers and facilities for the procedure.

Results:

We identified 5,119 patients undergoing open ganglion cyst excision and 20 patients undergoing arthroscopic ganglion excision. The average cost of an open excision was significantly lower than an arthroscopic excision ($1,821 vs $3,668).

Conclusions:

Surgical costs from arthroscopic ganglion excision are significantly more than open excision. This data can inform health systems participating in value-based models.

Type of study/level of evidence:

Economic and Decision Analysis IV.

Keywords:

Wrist arthroscopy; cost; ganglion cyst; quality; value.

Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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Ganglion cyst removal – Tartu Ülikooli Kliinikum

Removal
A ganglion cyst is called a ganglionectomy. This is a surgical procedure in
during which the doctor removes the cyst from your arm, leg, or some other
body parts. A ganglion cyst is a swollen sac under the skin attached to
near the joint, in the area of ​​attachment of ligaments and tendons, periarticular
bags. The cyst contains fluid identical to intra-articular.

Alternative
ganglionectomy is:

• fluid removal
  with a needle or syringe, with or without a cortisone injection.
• possibility not
  treat, taking into account the state of their health.

Information
Ask your doctor about the use of these possibilities.

Preparation for procedure

Not
eat and drink nothing (not even coffee, tea and water) after midnight and in the morning
before the operation.

If
the operation is performed under general anesthesia, after the operation someone
take home. Find someone who can do your daily chores instead of you.
worries for the time you have to rest.

Follow
doctor’s prescription. Do not smoke before and after the procedure. Smokers get hurt
heal more slowly. They are also more likely to have problems with
breathing during anesthesia and surgery. It is necessary to quit smoking no less than
2 weeks before the procedure.

Proceedings

You
You will be given general, local or local anesthesia.

At
local and local anesthesia operating place on the body is done
insensitive, at this time you yourself are conscious. During the local
and local anesthesia, you may be given a sedative to keep you calm.

General
anesthesia relaxes all your muscles while you sleep.

All
forms of anesthesia give you the opportunity to
during the operation, do not feel pain. The surgeon makes an incision around
cysts, then removes it. After that, he puts stitches on the internal incision.

Postoperative period

You
you can go home the same day. The doctor will suggest you to remove the stitches
see your family doctor in about 1-2 weeks.

Possible complications and dangers

• Complications may be due to anesthesia.
  Discuss them with your doctor.
• Local or local anesthesia may not be fully
  remove the sensitivity of the operating site and you can feel
  some inconvenience.

B
In rare cases, there may be an allergic reaction to the medicine used in
anesthesia. Local or local anesthesia is safer than general anesthesia.

• The cyst may recur.
• There is a slight risk of inflammation
  or bleeding, although usually the surgical wound heals quickly and without
  problems.
• In rare cases, there may be damage to the nerves and
  blood vessels.
• A healing wound may leave a noticeable scar.
  Usually, the scar becomes invisible with time.

Consult
with your doctor to find out what your dangerous risks are.

Call your doctor if:

• Your pain has increased despite taking pain medication prescribed by your doctor.
• If you notice purulent discharge, redness, swelling, tenderness when touching the surgical site or around the stitches.

Translation: sister of the Department of Abdominal Surgery Svetlana Reilly

Spinal cysts (spinal cysts) – Avicenna Klinik

• Start page
• Diseases of the spine
• Cysts of the spine (spinal cysts)

What are spinal cysts?

Cysts are cavities that form in tissue and are surrounded by a membrane or wall. A cyst may consist of one or more chambers. The interior is filled with tissue fluid, cerebrospinal fluid, blood, or some mushy content. Cysts can occur for various reasons anywhere in the body. Most cysts are harmless. However, depending on what the cause of the cyst is, what organ it is in, how large it is, where they come from, and how they behave, these formations can also create problems. So, for example, in the spinal canal of the spine, cysts can put pressure on surrounding structures. As a result, there is a typical symptomatology of the so-called radicular syndrome. Like a herniated disc, a cyst is also an extra piece of tissue in the spinal canal for which there is no room. In the spinal canal, especially the nerve roots can be suppressed by the cyst.

There are two main types of cysts on the spine, the so-called parineural cysts and synovial cysts (articular cysts, ganglion cyst, pseudocyst). In most cases, these are articular cysts, also called articular ganglia. Often, other degenerative changes also appear at the same level of the ganglion cyst, such as wear and tear, spinal canal stenosis, or slippage of a vertebra.

Cysts have a long history: they were first discovered and described in 1885 by the British surgeon William Maurrant Baker (1839- 1896). In 1950, a facet joint cyst was first described as the cause of nerve root compression.

Ganglion Cyst lumbar spinal canal

How often do cysts form in the spinal canal?

Cysts are less common than narrowing of the lumbar canal (spinal canal stenosis) or herniated discs (herniated discs), but they are being diagnosed more frequently as magnetic resonance imaging (MRI) imaging improves. Scientific studies assume that 1% of synovial cysts are found on MRI images of patients. Synovial cysts occur predominantly in the lumbar spine, namely in 90% of cases. Of these, in turn, 70% falls on the 4th and 5th lumbar vertebrae. Patients are mostly between the ages of 58 and 67, and the disease affects slightly more women than men.

Why do cysts develop?

Cysts may be congenital or acquired. Congenital are formed as a result of defects in the development of embryonic tissue. The acquired cyst develops against the background of inflammatory and degenerative diseases of the spine, as well as injuries and stress. There are still many questions around the formation of articular cysts. In other words, the formation of articular cysts is completely unclear. Science suggests that a worn joint of a vertebra promotes the multiplication of cells in its joint capsule, which then extends into the spinal canal and presses on the nerve roots. Thus, degeneration comes to the fore: as a result of excessive stress and inflammation of small joints, the joint capsule may rupture and, as a result, a cyst may develop in the spinal canal. Syringomyelia is a cystic mass in the central canal of the spinal cord.

Spinal cyst symptoms – radiating persistent pain

Ganglion cysts can spread in the spinal canal in all directions. Outwardly directed synovial cysts are most often asymptomatic. It’s different with cysts that point inward, i.e., growing into the spinal canal. Already from a size of a few millimeters, articular cysts cause symptoms such as a herniated disc. However, most patients, unlike classic spinal stenosis, complain not of back pain, but almost exclusively of radiating, excruciatingly persistent nerve pain radiating to the leg, depending on which nerve root is compressed. In fact, discomfort appears not only during movement, but during rest. In part, symptoms such as numbness or even muscle paralysis also appear. Especially in older, partially calcified cysts, the discomfort begins slowly and gradually builds up. Rarely does improvement occur on its own, so for most patients surgery is unavoidable.

Perineural cyst – Tarlov cyst

Diagnosis of a cyst – first a conversation to collect analysis

Diagnosis begins with the first step, and you must take it: it’s a visit to the doctor! Of course, there is pain that comes and goes and should not be taken seriously. Most often, the victim himself feels whether he needs to see a doctor. But basically there are instructions that clearly signal: yes, you need to see a doctor. Then the second step is the discussion of the disease. It is necessary to explain to the doctor the reasons for your visit, describe the complaints. Usually, after a conversation, the doctor begins the diagnosis with instrumental methods, after which he must decide which technique will help him. When looking for a possible cyst, the doctor will not order an x-ray because the x-ray will not show the cyst effectively. The x-ray cannot detect the cyst. One of the main methods for diagnosing cysts in the spine is magnetic resonance imaging. It is the imaging standard that best shows changes in the spinal region (narrowing of the spinal canal, disc herniation, cysts, tumors, bleeding, inflammation) and accurately shows the localization and expansion of joint cysts. If you live with a pacemaker, your doctor will choose computed tomography (CT) because MRI is not possible in patients with a pacemaker.

Treatment – how is the cyst problem solved?

Whether and how to treat a cyst, the doctor decides individually in each case. Ideally, of course, together with you. Ultimately, the question is: should the symptoms simply be alleviated, or should the problem be addressed at the root? To relieve your symptoms, your doctor may give you a cortisone injection. After that, you can live for several weeks without complaints, but this does not eliminate the cause. In some cases, there may be spontaneous contraction of the synovial cyst, but this is extremely rare. In addition, an empty cyst refills with fluid relatively quickly, and then begins to press on the surrounding structures again, so that the discomfort quickly returns. The cyst can only be removed surgically.

Thus, microsurgical decompression surgery is the treatment of choice for definitive treatment. It causes a rapid reduction or complete elimination of complaints. In a minimally invasive operation, a 3 cm skin incision is made in the center of the back. At the same time, under an operating microscope, the joint cyst is completely separated from the surrounding nerve roots (since adhesions are common) and removed. For some cysts caused by parasites, a targeted antibiotic often helps.

Prognosis – after removal of the cyst, you will finally have no pain

The presence of a cyst in itself is not yet a disease. Only when the cyst expands, requires space, causes pain and other health problems, does it become a burden on the patient. But it is also a warning signal. It is only important to take this signal seriously. So: go see a doctor, ideally a neurosurgeon or orthopedist, when movement and even rest becomes a pain. If the joint cyst has been successfully operated on and removed from your body, if it can no longer cause harm, the prognosis for your future daily life is: LIFE WITHOUT PAIN!

Author
Dr.