Carpal Tunnel Release: A Four-Specialty Comparison Demonstrating Equal Clinical and Economic Efficacy

TL;DR

This study compares carpal tunnel surgery outcomes across four surgical specialties and finds similar costs and complication rates.

Contribution

The study provides empirical evidence of equal clinical and economic outcomes for carpal tunnel release across four surgical specialties.

Findings

Plastic and neurosurgeons had the highest average costs, while general surgeons had the lowest.

Neurosurgeons ordered the most preoperative EMG and nerve conduction studies.

General and neurosurgeons had slightly higher infection rates than orthopedic and plastic surgeons.

Abstract

Carpal tunnel release (CTR), the most common hand surgery procedure in the United States, is routinely performed by orthopedic surgeons, neurosurgeons, plastic surgeons, and general surgeons. There is limited literature comparing clinical costs and research utilization among specialties. This study sought to determine treatment utilization, variations in cases, and cost trends among orthopedic, plastic, general, and neurosurgeons.

A national insurance database was queried for patients who underwent open or endoscopic CTR between the years 2007 and 2022. Four cohorts based on provider specialty, orthopedic, plastic, general, and neurosurgery, were matched using the following factors: age, sex, diabetes, obesity, tobacco use, location of procedure, and Elixhauser Comorbidity Index. Average cost by specialty was then calculated and compared. Rates of therapy within 3 months after surgery and EMG and nerve conduction velocity studies within 3 months before the procedure were also compared.

The matched cohorts consisted of 13,107 patients each. Plastic surgeons and neurosurgeons had the highest average cost ($2,923.29 and $2,922.58), followed by orthopedic surgeons ($2,765.95), with general surgeons having the lowest cost ($2,607.02). Rates of preoperative EMG and nerve conduction studies were highest with neurosurgeons (28.5%), followed by orthopedics and plastics (22.6% and 23.4%, respectively), with general surgeons ordering the fewest (19.7%). For complications, general surgeons and neurosurgeons had a small but statistically higher infection rate (0.8%, 0.7% respectively) compared with orthopedic and plastic surgeons (0.5%, 0.5%).

The current study demonstrates that overall orthopedic, plastic, neurosurgery, and general surgeons perform CTRs with similar overall costs and with similar postoperative complications.

Economic/decision analysis III.