Determining the Operative Efficiency of Ankle Arthroscopy with a Standard Arthroscope vs Nanoscope

Abstract

Category: Arthroscopy; Ankle Introduction/Purpose: Ankle arthroscopy is a commonly performed surgical procedure. Needle arthroscopy - performed with a nanoscope (Arthrex, Naples, FL) - has recently been introduced as an alternative to traditional arthroscopy, with goals of reducing pre-procedure set-up time, size of incisions, and minimizing soft tissue injury. To date, the efficiency of nanoscope use in ankle arthroscopy has not been investigated. The purpose of this study is to use time-driven activity-based costing (TDABC) to compare the single-use nanoscope to the reusable 2.7-millimeter small joint arthroscope in performing ankle arthroscopy procedures to understand cost and efficiency. We hypothesize that the nanoscope is the more cost-effective approach because it is not associated with the costs of reprocessing and allows for quicker operating room (OR) setup time. Methods: This is a prospective study of hand-timed collection of procedure times and a retrospective review of procedure costs. Four authors directly hand-timed ankle arthroscopy procedure setup and operative cases performed by one of two fellowship- trained foot and ankle surgeons at a single academic medical center. In total, 21 procedures were timed (arthroscope=10, nanoscope=11). Furthermore, using TDABC, we calculated procedure costs with each device. Costs of reprocessing reusable equipment, operating room time per minute (mean, $36.14/min), sterile processing, department and operating room labor, and maintenance were gathered from literature values and facility accounting systems. These direct and indirect costs were summed into the total cost for each of the surgical techniques, and a sensitivity analysis was performed to determine which of the variables had the most significant effect on overall procedure cost. Results: There was a statistically significant difference in OR opening time (arthroscope=10.28 minutes, nanoscope=4.83 minutes; p=.021) and incision to joint space time (arthroscope=2.19 minutes, nanoscope=1.26 minutes; p=.007) between devices, but no difference concerning set-up or total case intraoperative times. (Table 1) There was no difference in total OR time cost, though the nanoscope group was lower than the arthroscope group (arthroscope= $1,171.48, nanoscope=$916.60; p=.066). With regard to the costs of instrument cleaning, OR turnover, and device setup, the total cost for standard arthroscope use was $1,265.73, as compared to $968.28 for the nanoscope (p=.038). However, the use of the standard arthroscope was less costly when the OR turnover time was less than 24.18 minutes or the OR time costs were less than $26.96 per minute. Conclusion: Overall, the nanoscope was significantly more efficient than the 2.7-millimeter reusable scope regarding opening time and incision to joint space time in the OR. Ankle arthroscopy utilizing a traditional arthroscope is 30.7% more expensive than with the use of a nanoscope and takes longer to set up. Operating room cost per minute and room turnover time are the primary factors driving procedural cost. Given the similar clinical indications of both devices, understanding the cost differences between devices may assist in clinician decision-making to guide the optimization of facility procedures in the operating room.