Temporal trend of carpal tunnel release surgery: a population-based time series analysis.
BACKGROUND
Carpal tunnel release (CTR) is among the most common hand surgeries, although little is known about its pattern. In this study, we aimed to investigate temporal trends, age and gender variation and current practice patterns in CTR surgeries.


METHODS
We conducted a population-based time series analysis among over 13 million residents of Ontario, who underwent operative management for carpal tunnel syndrome (CTS) from April 1, 1992 to March 31, 2010 using administrative claims data.


RESULTS
The primary analysis revealed a fairly stable procedure rate of approximately 10 patients per 10,000 population per year receiving CTRs without any significant, consistent temporal trend (p = 0.94). Secondary analyses revealed different trends in procedure rates according to age. The annual procedure rate among those age >75 years increased from 22 per 10,000 population at the beginning of the study period to over 26 patients per 10,000 population (p<0.01) by the end of the study period. CTR surgical procedures were approximately two-fold more common among females relative to males (64.9% vs. 35.1 respectively; p<0.01). Lastly, CTR procedures are increasingly being conducted in the outpatient setting while procedures in the inpatient setting have been declining steadily - the proportion of procedures performed in the outpatient setting increased from 13% to over 30% by 2010 (p<0.01).


CONCLUSIONS
Overall, CTR surgical-procedures are conducted at a rate of approximately 10 patients per 10,000 population annually with significant variation with respect to age and gender. CTR surgical procedures in ambulatory-care facilities may soon outpace procedure rates in the in-hospital setting.
College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Naif
N
Fnais
The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Tara
T
Gomes
Division of Plastic & Reconstructive Surgery, Saint Michael's Hospital, Toronto, Ontario, Canada.
James
J
Mahoney
Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada.
Sami
S
Alissa
Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada; The Keenan Research Centre of the Li KaShing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Muhammad
M
Mamdani
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008475:Median Nerve / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009864:Ontario; D010045:Outpatients / Q000706:statistics & numerical data*; D012737:Sex Factors; D013997:Time Factors; D014953:Wrist / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*