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. 2025 Oct 10.
doi: 10.1097/SAP.0000000000004522. Online ahead of print.

Forecasting Trends in Inpatient and Outpatient Utilization of Open and Endoscopic Carpal Tunnel Release Procedures Through 2040

Eric Wang  1 , M Lane Moore  2 , Katelyn T Koschmeder  2 , Collin L Braithwaite  2 , Kevin J Renfree  2
Affiliations

Forecasting Trends in Inpatient and Outpatient Utilization of Open and Endoscopic Carpal Tunnel Release Procedures Through 2040

Eric Wang et al. Ann Plast Surg. .

Abstract

Background: Carpal tunnel release (CTR) is one of the most frequently performed procedures in the United States, with both open (OCTR) and endoscopic (ECTR) techniques widely used. As surgical practices evolve and outpatient care expands, understanding future utilization trends across care settings is increasingly important. This study projects the use of OCTR and ECTR through 2040 to inform shifting surgical preferences and healthcare demands.

Methods: This study analyzed procedural data from 2010 to 2019 using the PearlDiver Mariner all-payer claims database. Cases of OCTR and ECTR were identified using Current Procedural Terminology codes. Procedures were further stratified by inpatient or outpatient status based on the documented site of service field within the database. Log-linear, Poisson, negative binomial regression, and autoregressive integrated moving average (ARIMA) models were applied to procedural volumes to project trends through 2040. The ARIMA model was selected based on the lowest normalized root mean square error and overall model performance.

Results: In 2019, there were 31,190 outpatient ECTR, 155 inpatient ECTR, 101,334 outpatient OCTR, and 1359 inpatient OCTR procedures. By 2040, outpatient ECTR is projected to grow to 65,072 cases (95% CI, 62,471-67,781) at 3.79% annually. Inpatient ECTR is projected to reach 181 cases (95% CI, 97-340) with 2.13% annual growth. Outpatient OCTR is expected to decline to 77,834 cases (95% CI, 76,287-79,413), and inpatient OCTR to 962 cases (95% CI, 809-1143), with annual decreases of 1.19% and 1.48%, respectively.

Conclusions: By 2040, demand for outpatient ECTR is projected to increase by 110.31% compared to 2019, whereas outpatient OCTR is expected to decline by 20.31%. Although inpatient utilization remains limited, the adoption of endoscopic techniques is anticipated to rise across all care settings, in contrast to the continued decline of open procedures. These trends highlight the ongoing shift toward minimally invasive, ambulatory surgical care. Strategic planning in surgical training, healthcare infrastructure, and reimbursement models will be critical to meet changing demands. Further research is needed to validate these projections in broader populations and across diverse healthcare systems.

Keywords: ECTR; OCTR; carpal tunnel release; endoscopic carpal tunnel release; open carpal tunnel release; outpatient surgery; projection; utilization.

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Conflict of interest statement

Conflicts of interest and sources of funding: none declared.

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