Surgical Excision Versus Percutaneous Ultrasound-Guided Fenestration for Pediatric Ganglia: A Cost and Recurrence Rate Analysis

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Abstract
Introduction: Although 10% of ganglia occur in children, data on effective treatment modalities and recurrence rates remain sparse, and costs of treatment remain unknown. This study aims to characterize the treatment costs and rates of revision in pediatric ganglia managed surgically versus with percutaneous ultrasound-guided ganglion fenestration (PUGG). Methods: This nonclinical retrospective cohort examined patients treated for wrist ganglia at a tertiary pediatric referral center from December 1, 2011, to March 15, 2023. Data were collected from billing records regarding procedure type and date, primary payor, and total treatment costs. Patients were stratified into two cohorts: those undergoing surgery and those undergoing PUGG. Patient data were analyzed for treatment choice, associated rates of revision, and episodic and total costs of care. Results: Five hundred eighty-nine patients comprised our cohort with 710 procedures performed. PUGG was markedly less expensive than surgery ($2,217 vs. $116,456; P < 0.001), a trend noted across both public ( P < 0.001) and private ( P < 0.001) insurers. Patients undergoing PUGG had markedly lower revision rates (15% vs. 22%; P < 0.001) but shorter mean time to revision (303 days vs. 1,610; P < 0.001) compared with surgical intervention. Overall treatment costs were markedly lower in patients treated initially with PUGG ($3,713 vs. $13557; P < 0.001). Conclusion: This study provides much-needed data on treatment-related costs of pediatric ganglia. PUGG presents as an alternative option for pediatric wrist ganglia management due to its cost-effectiveness and comparable revision rates. Overall, PUGG can serve as a cost-effective management strategy for pediatric wrist ganglia.

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