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. 2017 Mar;12(2):162-167.
doi: 10.1177/1558944716643276. Epub 2016 Jul 8.

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications

Brock D Foster  1 , Lakshmanan Sivasundaram  1 , Nathanael Heckmann  1 , Jeremiah R Cohen  1 , William C Pannell  1 , Jeffrey C Wang  1 , Alidad Ghiassi  1
Affiliations

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications

Brock D Foster et al. Hand (N Y). 2017 Mar.

Abstract

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.

Keywords: United States; carpal tunnel release; carpal tunnel syndrome; epidemiology.

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Conflict of interest statement

Declaration of Conflicting Interests: JCW reports nonfinancial support from the North American Spine Society, nonfinancial support from the Cervical Spine Research Society, personal fees from the AO Spine/AO Foundation, and other support from DepuySynthes, outside the submitted work.

Figures

Figure 1.
Figure 1.
Temporal trend in the use of general and local anesthesia for carpal tunnel release from 2007 to 2011. Note. The y-axis on the left is for general or regional anesthesia while the y-axis on the right is for local anesthesia.
Figure 2.
Figure 2.
Temporal trends in the surgical technique utilized for carpal tunnel release from 2007 to 2011. Note. The y-axis on the left is for open surgery while the y-axis on the right is for local anesthesia.
Figure 3.
Figure 3.
Average hospital charge per procedure type for carpal tunnel release.
See this image and copyright information in PMC

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