title: Effects of Hand Fellowship Training on Rates of Endoscopic and Open Carpal Tunnel Release.
abstract: OBJECTIVE
  To investigate rates, trends, and complications for carpal tunnel release (CTR) related to fellowship training using the American Board of Orthopaedic Surgery Part II Database.
  
  
  METHODS
  We searched the American Board of Orthopaedic Surgery database for patients with carpal tunnel syndrome who underwent either open carpal tunnel release (OCTR) or endoscopic (ECTR) from 2003 to 2013. Cases with multiple treatment codes were excluded. Data were gathered on geographic location, fellowship, and surgical outcomes. Data were then divided into 2 cohorts: hand fellowship trained versus non-hand fellowship trained. We performed analysis with chi-square tests of independence and for trend.
  
  
  RESULTS
  Overall, 12.4% of all CTRs were done endoscopically. Hand fellowship-trained orthopedists performed about 4.5 times the number of ECTR than did non-hand fellowship-trained surgeons. An increasing trend over time of ECTR was seen only among the hand fellowship cohort. The northwest region of the United States had the highest incidence (23.1%) of ECTR, and the Southwest the lowest incidence (5.9%). The complication incidence associated with CTR overall was 3.6%, without a significant difference between ECTR and OCTR. Within the hand fellowship cohort the complication incidence for ECTR was significantly less than for OCTR. There was no difference in overall complication rates with ECTR and OCTR between the 2 cohorts. Wound complications were higher with OCTR (1.2% vs 0.25%) and nerve palsy with ECTR (0.66% vs 0.27%); with postoperative pain equivalent between techniques independent of fellowship training.
  
  
  CONCLUSIONS
  Within the United States from 2003 to 2013, the rate of ECTR increased, as did complications. However, complication rates remained low in the first 2 years of practice. Hand fellowship-trained surgeons performed more ECTR than did non-hand fellowship-trained orthopedic surgeons, and both groups had similar complication rates.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: bsmetana@unch.unc.edu.
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Smetana
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, NC.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.affiliation: American Board of Orthopaedic Surgeons, Chapel Hill, NC.
authors.forename: Shep
authors.initials: S
authors.lastname: Hurwitz
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Ganesh V
authors.initials: GV
authors.lastname: Kamath
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: J Megan M
authors.initials: JM
authors.lastname: Patterson
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000193:education / Q000706:statistics & numerical data*; D005257:Fellowships and Scholarships; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000193:education / Q000706:statistics & numerical data*; D009985:Orthopedics / Q000193:education*; D014481:United States
keywords: American Board of Orthopaedic Surgeons; endoscopic versus open carpal tunnel release; hand fellowship; rate; trend