title: Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome: A systematic review and meta-analysis.
abstract: BACKGROUND
  Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disease. Either surgical or conservative intervention for CTS patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical efficacy, safety, and cost of surgical versus nonsurgical intervention.
  
  
  METHODS
  The eligible studies were acquired from PubMed, Medline, Embase, Web of Science, Google, and Cochrane Library. The data were extracted by 2 of the coauthors independently and were analyzed by RevMan5.3. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.
  
  
  RESULTS
  Thirteen studies including 9 randomized controlled trials (RCTs) and 4 observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The difference of clinical efficacy was statistically significant between surgical and nonsurgical intervention, and nonsurgical treatment was more effective (OR = 2.35, 95%CI = 1.18-4.67, P = 0.01). Meanwhile, different results were discovered by subgroup analysis. The pooled results of function improvement, symptom improvement, neurophysiological parameters improvement, and cost of care at different follow-up times showed that the differences were not statistically significant between the 2 interventions. The difference of complications and side-effects was statistically significant and conservative treatment achieved better result than surgery (OR = 2.03, 95%CI = 1.28-3.22, P = 0.003). Sensitivity analysis proved the stability of the pooled results.
  
  
  CONCLUSIONS
  Both surgical and conservative interventions had benefits in CTS. Nonsurgical treatment was more effective and safety than surgical treatment, but there were no significant differences in function improvement, symptom improvement, neurophysiological parameters improvement, and cost of care. Nonsurgical treatment is recommended as the optical choice for CTS. If conservative treatment fails, surgical release can be taken.
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China Department of Orthopedics, People's Hospital of Rizhao, Shandong, China.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Ren
authors.forename: Xi-Shan
authors.initials: XS
authors.lastname: Wang
authors.forename: Zhi-Jian
authors.initials: ZJ
authors.lastname: Wei
authors.forename: Bao-You
authors.initials: BY
authors.lastname: Fan
authors.forename: Wei
authors.initials: W
authors.lastname: Lin
authors.forename: Xian-Hu
authors.initials: XH
authors.lastname: Zhou
authors.forename: Shi-Qing
authors.initials: SQ
authors.lastname: Feng
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000191:economics / Q000628:therapy*; D000072700:Conservative Treatment / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D019635:Neurosurgical Procedures / Q000191:economics; D016896:Treatment Outcome