Safety and Cost-Effectiveness of In-Office Digital Mucous Cyst Excisions

Abstract

Background:

Digital mucous cysts are a common lesion of the distal interphalangeal joint that can be treated nonoperatively with steroid injections and aspirations. Those who fail conservative treatment may undergo surgical removal of the cyst in the operating room; however, with rising health care costs, there has been a trend toward in-office-based hand surgery. This study examines the effectiveness, safety, and cost-effectiveness of performing this excision in the office.

Methods:

A retrospective cohort of consecutive patients who underwent in-office digital mucous cyst excision was established. Patient demographics, perioperative symptoms, and outcomes were recorded to examine the success rate of office-based cyst removal and characterize the postoperative infection/complication rate.

Results:

Sixty-seven patients underwent in-office cyst removal with a 95.5% success rate, with 3 patients having cyst recurrence. Full resolution of symptoms was seen in 89.4% of patients by 2 weeks and 100% by 12 weeks postoperation. There were 7 postoperative infections (10.4%), 6 of which were superficial and resolved with oral antibiotics. There was one deep infection that resolved following operative irrigation and debridement. There was no significant relationship between the use of perioperative antibiotics and postoperative infection. There was a significant relationship between the presence of medical comorbidities and the development of postoperative infection (P = .027). The cost of a digital mucous cyst excision in the hospital was found to be an 8.5-fold increase compared with the in-office excision.

Conclusions:

In-office excision is a cost-effective, safe, and successful option for treating digital mucous cysts, demonstrating a low rate of recurrence, infection, and persistent symptoms.

Type of Study/Study level: Retrospective Cohort, Level III evidence.