Impact of Economic Downturn on the Surgical Volumes of Common Hand Procedures

Background: Economic conditions affect surgical volumes, particularly for elective procedures. In this study, we aimed to identify the effects of the 2008 US economic downturn on hand surgery volumes to guide surgeons and managers when facing future economic crises. Methods: We used the California State Ambulatory Surgery and Services Databases from January 2005 to December 2011, which includes the entire period of the Great Recession (December 2007 to June 2009). We abstracted the monthly volume of five common hand procedures using ICD-9 and CPT codes. Pearson's statistics were used to identify the correlation between unemployment rate and surgical volume for each procedure. Results: The total number of operative cases was 345,583 during the study period of seven years. Most common elective hand procedures, such as carpal tunnel release and trigger finger release had a negative correlation with the unemployment rate, but the volume of distal radius fracture surgery did not show any correlation. Compared with carpal tunnel release (r = -0.88) or trigger finger release volumes (r = -0.85), thumb arthroplasty/arthrodesis volumes (r = -0.45) showed only a moderate correlation. Conclusions: The economic downturn decreased elective hand procedure surgical volumes. This may be detrimental to small surgical practices that rely on revenue from elective procedures. Taking advantage of the principle that increased volume reduces unit cost may mitigate the lost revenue from these elective procedures. In addition, consolidating hand surgery services at larger, regional centers may reduce the effect of the economic environment on individual hand surgeons. Financial Disclosure Statement: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 2 K24-AR053120-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In addition, it was funded by the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161). Corresponding Author: Kevin C. Chung MD, MS, Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5340, Kecchung@med.umich.edu, Phone: 734-936-5885, Fax: 734-763-5354 ©2018American Society of Plastic Surgeons

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