Multistate Comparison of Cost, Trends, and Complications in Open Versus Endoscopic Carpal Tunnel Release

Williamson, Emilie; Montes, Dennis Vasquez; Melamed, Eitan

doi:10.1177/1558944719837020

Cited by 29 publications

(25 citation statements)

References 13 publications

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“…Third, the wrist and hand muscles are usually weak and usually get smaller due to severe compression of the median nerve. Lastly, doctors recommend surgery when the syndrome's symptoms last more than six months without any relief [26]. In essence, non-surgical therapies would be the best option when one suspects they have carpal tunnel syndrome.…”

Section: Carpal Tunnel Release Surgerymentioning

confidence: 99%

Carpal Tunnel Syndrome: A Review of Literature

Genova¹,

Dix²,

Saefan³

et al. 2020

Cureus

171

140

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Carpal tunnel syndrome (CTS) is a common medical condition that remains one of the most frequently reported forms of median nerve compression. CTS occurs when the median nerve is squeezed or compressed as it travels through the wrist. The syndrome is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerve. Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation. The diagnosis of CTS is conducted through medical assessments and electrophysiological testing, although idiopathic CTS is the most typical method of diagnosis for patients suffering from these symptoms. The pathophysiology of CTS involves a combination of mechanical trauma, increased pressure, and ischemic damage to the median nerve within the carpal tunnel. The diagnosis of CTS patients requires the respective medical professional to develop a case history associated with the characteristic signs of CTS. In addition, the doctor may question whether the patients use vibratory objects for their tasks, the parts of the arm where the sensations are felt, or if the patient may already have predisposing factors for CTS incidence. During the diagnosis of CTS, it is essential to note that other conditions may also provide similar symptoms to CTS, thus requiring vigorous diagnosis to assert the medical condition of the patients. Doctors use both non-surgical and surgical treatments when addressing CTS. Non-surgical treatments include wrist splinting, change of working position, medications, and the use of alternative non-vibrating equipment at work. On the other hand, surgical methods include open release and endoscopic surgeries. This review of literature has provided an overview of CTS with an emphasis on anatomy, epidemiology, risk factors, pathophysiology, stages of CTS, diagnosis, and management options.

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Section: Carpal Tunnel Release Surgerymentioning

confidence: 99%

Carpal Tunnel Syndrome: A Review of Literature

Genova¹,

Dix²,

Saefan³

et al. 2020

Cureus

171

140

View full text Add to dashboard Cite

show abstract

“…Despite these limitations, the methodology used in this study has been demonstrated to be useful in several previous orthopaedic studies. 1,2,4,12,13,24 The goal of this study was to analyze how surgeon- and patient-specific factors are associated with cost, and further studies may aim to delve deeper into the trends identified. Although there are limitations inherent in this analysis, the trends identified can prove useful to surgeons and patients alike.…”

Section: Discussionmentioning

confidence: 99%

High-Volume and Privately Owned Ambulatory Surgical Centers Reduce Costs in Achilles Tendon Repair

Chuck

Bokshan

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: While Achilles tendon repairs are common, little data exist characterizing the cost drivers of this surgery. Purpose: To examine cases of primary Achilles tendon repair, primary repair with graft, and secondary repair to find patient characteristics and surgical variables that significantly drive costs. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: A total of 5955 repairs from 6 states were pulled from the 2014 State Ambulatory Surgery and Services Database under the Current Procedural Terminology codes 27650, 27652, and 27654. Cases were analyzed under univariate analysis to select the key variables driving cost. Variables deemed close to significance ( P < .10) were then examined under generalized linear models (GLMs) and evaluated for statistical significance ( P < .05). Results: The average cost was $14,951 for primary repair, $23,861 for primary repair with graft, and $20,115 for secondary repair ( P < .001). In the GLMs, high-volume ambulatory surgical centers (ASCs) showed a cost savings of $16,987 and $2854 in both the primary with graft and secondary repair groups, respectively (both P < .001). However, for primary repairs, high-volume ASCs had $2264 more in costs than low-volume ASCs ( P < .001). In addition, privately owned ASCs showed cost savings compared with hospital-owned ASCs for both primary Achilles repair ($2450; P < .001) and primary repair with graft ($11,072; P = .019). Time in the operating room was also a significant cost, with each minute adding $36 of cost in primary repair and $31 in secondary repair (both P < .001). Conclusion: Private ASCs are associated with lower costs for patients undergoing primary Achilles repair, both with and without a graft. Patients undergoing the more complex secondary and primary with graft Achilles repairs had lower costs in facilities with greater caseload.

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“…Other studies using different accounting methods all generally agree that the immediate procedural costs of ECTR exceed those of OCTR, some estimates by as much as $2,000 per case. 29,30 Direct costs are not limited to the choice of procedure, but also encompass surgical setting (procedure room versus operating room) and anesthesia choice (local, monitored anesthesia care, Bier block, and general). Kazmers et al used their institutional data to calculate total direct costs of carpal tunnel release surgical encounters and found that performing OCTR in the procedure room under local anesthesia was the least costly technique.…”

Section: Direct Costmentioning

confidence: 99%

Endoscopic Carpal Tunnel Release: Techniques, Controversies, and Comparison to Open Techniques

Hacquebord

Chen

Rettig

2022

J Am Acad Orthop Surg

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Endoscopic carpal tunnel release (ECTR) continues to rise in popularity as a treatment option for carpal tunnel syndrome. Numerous variations in technique and instrumentation currently exist, broadly classified into two-portal and single-portal techniques with antegrade and retrograde designs. ECTR is equally effective as open carpal tunnel release for alleviating symptoms of carpal tunnel syndrome with no differences in long-term outcomes. ECTR has an increased risk of transient nerve injury, whereas open carpal tunnel release has an increased risk of wound and scar complications. ECTR has higher direct costs but is associated with earlier return to work. ECTR is a safe and effective approach to carpal tunnel release in the hands of experienced surgeons. Carpal tunnel syndrome is the most common compressive peripheral neuropathy within the United States with an incidence of 1 to 3 cases per 1,000 patients per year and a prevalence as high as 5% in the general population. 1,2 Its diagnosis carries significant disability and economic burden with approximately 500,000 carpal tunnel releases performed annually and economic cost estimates in excess of $2 billion per year within the United States alone. 3 Timely surgical intervention after failure of conservative measures may reduce economic loss and prevent permanent disability and need for reconstructive procedures. 1 Both open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR) are popular techniques for surgical treatment of carpal tunnel syndrome. Although there currently is no consensus regarding the choice of one over the other, rates of ECTR continue to rise. Between 2005 and 2012, 14% of all carpal tunnel releases performed in the Medicare database were done endoscopically, with rates of ECTR growing by 5% annually compared with 0.9% annually for OCTR (P , 0.001). 4 Recent survey studies of the members of the American Society for Surgery of the Hand have shown as many as 26% to 36% of members using ECTR for most of their cases. 5,6 Looking at young surgeons specifically, a query of the American Board of Orthopaedic Surgery Part II database revealed an increasing proportion of carpal tunnel releases performed endoscopically, with hand fellowship-

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Multistate Comparison of Cost, Trends, and Complications in Open Versus Endoscopic Carpal Tunnel Release

Cited by 29 publications

References 13 publications

Carpal Tunnel Syndrome: A Review of Literature

Carpal Tunnel Syndrome: A Review of Literature

High-Volume and Privately Owned Ambulatory Surgical Centers Reduce Costs in Achilles Tendon Repair

Endoscopic Carpal Tunnel Release: Techniques, Controversies, and Comparison to Open Techniques

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