20. the cost effectiveness of point-of-care ultrasound in the diagnosis of ganglion cysts of the hand and wrist

PURPOSE: Point-of-care ultrasound (POCUS) is becoming increasingly practical among various surgical specialties due to portability, ease of use and cost effectiveness; however, this is heavily underutilized in Plastic Surgery and lacking among curriculums in residency programs. We sought to determine the cost-effectiveness of a hand-held portable ultrasound that could be easily utilized pre-operatively. METHODS: We performed a retrospective chart review of 349 patients undergoing ganglion cyst excision from January 1, 2016 to August 30, 2021. Pre-operative imaging studies and time to treatment were assessed. RESULTS: 34 patients received a pre-operative MRI and 20 received an ultrasound. The average cost of MRI was $283.61 and ultrasound $392.48. Over 5 years, the cumulative cost of MRI was $8,792 and ultrasound $10,512. Average time to treatment for patients without pre-operative imaging was 50.6 days, in comparison to 99.9 days for patients with imaging. Our results demonstrate that a portable, hand-held ultrasound utilized pre-operatively would be more cost effective than formal pre-operative imaging (device cost versus potential cumulative savings of $19,304), which also delays time to treatment and does not add to the doctor patient relationship as demonstrating imaging findings in real-time would. CONCLUSION: Pre-operative POCUS would decrease cost and decrease time to treatment in the management of ganglion cysts of the hand/wrist. Further investigation of the utility of POCUS in Plastic Surgery is necessary and underway at multiple institutions. We plan to perform an implementation trial which if effective, would warrant implementation of ultrasound education in all Plastic Surgery residency programs.