Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications.
Background:Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States.Methods:The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated.Results:We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia.Conclusions:In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.
University of Southern California, Los Angeles, USA.
Brock D
BD
Foster
University of Southern California, Los Angeles, USA.
Lakshmanan
L
Sivasundaram
University of Southern California, Los Angeles, USA.
Nathanael
N
Heckmann
University of Southern California, Los Angeles, USA.
Jeremiah R
JR
Cohen
University of Southern California, Los Angeles, USA.
William C
WC
Pannell
University of Southern California, Los Angeles, USA.
Jeffrey C
JC
Wang
University of Southern California, Los Angeles, USA.
Alidad
A
Ghiassi
D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000191:economics* / Q000379:methods* / Q000639:trends; D000765:Anesthesia, Conduction / Q000191:economics / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000191:economics / Q000706:statistics & numerical data; D002349:Carpal Tunnel Syndrome / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods / Q000639:trends; D004724:Endoscopy / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
United States; carpal tunnel release; carpal tunnel syndrome; epidemiology