Trends and Complications in Open Versus Endoscopic Carpal Tunnel Release in Private Payer and Medicare Patient Populations

Devana, Sai; Jensen, Andrew R.; Yamaguchi, Kent T.; D’Oro, Anthony; Buser, Zorica; Wang, Jeffrey C.; Petrigliano, Frank A.; Dowd, Casimir

doi:10.1177/1558944717751196

Cited by 43 publications

(42 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hence, therefore, patients should discuss such pre-existing medical conditions. Also, the patient should tell the doctor about any medications they are using, including herbs, over-the-counter medicines, supplements, and vitamins [27]. In some cases, the physician recommends advises the patient to stop using the medications that would complicate the blood clotting process such as naproxen, aspirin, and ibuprofen [28].…”

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

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.

show abstract

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

“…8,9 Although small observational studies have been able to investigate the risks of some postoperative infections and nerve injuries, the risk and incidence of reoperation, and rarer complications such as deep infection, have been poorly defined because of limitations in coding systems, and the difficulty in enabling full longitudinal follow-up of patients over time within multiple private healthcare systems, especially those that do not link to official mortality records. [10][11][12][13] Increasingly, evidence from routinely collected data is used to evaluate health-care interventions in the general population. 14 Outcome data from real world practice enables improved counselling of patients both before referral by primary care physicians, and before surgery.…”

Section: Introductionmentioning

confidence: 99%

Serious postoperative complications and reoperation after carpal tunnel decompression surgery in England: a nationwide cohort analysis

Lane

Craig

Rees

et al. 2021

The Lancet Rheumatology

View full text Add to dashboard Cite

Background Carpal tunnel decompression surgery to treat carpal tunnel syndrome is a common procedure, yet data on safety and effectiveness of the operation in the general population remain scarce. We aimed to estimate the incidence of reoperation and serious postoperative complications (requiring admission to hospital or further surgery) following carpal tunnel decompression in routine clinical practice and to identify the patient factors associated with these adverse outcomes. Methods We did a nationwide cohort analysis including all carpal tunnel decompression surgeries in patients aged 18 years or older, done in the National Health Service in England between April 1, 1998, and March 31, 2017, using the Hospital Episode Statistics dataset linked to mortality records. Patients were followed-up until death or until the end of the study (March 31, 2017). Primary outcomes were the overall incidence of carpal tunnel decompression reoperation and serious postoperative complications (surgical site infection or dehiscence, or neurovascular or tendon injury, requiring admission to hospital or further surgery) within 30 days and 90 days after surgery. Multivariable Cox regression analysis was used to identify factors influencing complications and reoperation, and the Fine and Gray method was used to adjust for the competing risk of mortality. This study is registered with ClinicalTrials.gov, NCT03573765. Findings 855 832 carpal tunnel decompression surgeries were done between April 1, 1998, and March 31, 2017 (incidence rate 1•10 per 1000 person-years [95% CI 1•02-1•17]). 29 288 procedures (3•42%) led to carpal tunnel decompression reoperation (incidence rate 3•18 per 1000 person-years [95% CI 3•12-3•23]). Of the 855 832 initial surgeries, 620 procedures (0•070% [95% CI 0•067-0•078]) led to a serious complication within 30 days after surgery, and 698 procedures (0•082% [0•076-0•088]) within 90 days. Local complications within 90 days after surgery were associated with male sex (adjusted hazard ratio 2•32 [95% CI 1•74-3•09]) and age category 18-29 years (2•25 [1•10-4•62]). Male sex (adjusted subhazard ratio 1•09 [95% CI 1•06-1•13]), old age (>80 years vs 50-59 years: 1•09 [1•03-1•15]), and greater levels of comorbidity (Charlson score ≥5 vs 0: 1•25 [1•19-1•32]) and socioeconomic deprivation (most deprived 10% vs least deprived 10%: 1•18 [1•10-1•27]) were associated with increased reoperation risk. Interpretation To our knowledge, this is the largest national study on carpal tunnel decompression to date, providing strong evidence on serious postoperative complication and reoperation rates. Carpal tunnel decompression appears to be a safe operation in most patients, with an overall serious complication rate (requiring admission to hospital or further surgery) of less than 0•1%.

show abstract

“…In an attempt to avoid these complications, Chow [12] and Okutsu et al [13] first reported the use of ECTR for the treatment of CTS in the English literature in 1989. This method allows for smaller skin incisions and better esthetic results than OCTR [1,14,15]. Nevertheless, ECTR is technically difficult, time consuming, and associated with incomplete transverse carpal ligament release and neurovascular injury [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

Luo

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS). We compared the effectiveness and safety of ECTR and OCTR based on evidence from a high-level randomized controlled trial. Methods: We comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Medline to identify relevant articles published until August 2019. Data regarding operative time, grip strength, Boston Carpal Tunnel Questionnaire scores, digital sensation, patient satisfaction, key pinch strength, return to work time, and complications were extracted and compared. All mean differences (MD) and odds ratios (OR) were expressed as ECTR relative to OCTR. Results: Twenty-eight studies were included in our meta-analysis. ECTR was associated with significantly higher satisfaction rates (MD, 3.13; 95% confidence interval [CI], 1.43 to 4.82; P = 0.0003), greater key pinch strengths (MD, 0.79 kg; 95% CI, 0.27 to 1.32; P = 0.003), earlier return to work times (MD, -7.25 days; 95% CI, -14.31 to -0.19; P = 0.04), higher transient nerve injury rates (OR, 4.87; 95% CI, 1.37 to 17.25; P = 0.01), and a lower incidence of scar-related complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). There were no significant differences between the two methods in terms of permanent nerve injury (OR, 1.93; 95% CI, 0.58 to 6.40; P = 0.28). Conclusions: Overall, evidence from randomized controlled trials indicates that ECTR results in better recovery of daily life functions than OCTR, as revealed by higher satisfaction rates, greater key pinch strengths, earlier return to work times, and fewer scar-related complications. Our findings suggest that patients with CTS can be effectively managed with ECTR.

show abstract

Trends and Complications in Open Versus Endoscopic Carpal Tunnel Release in Private Payer and Medicare Patient Populations

Abstract: In both the Medicare and private insurance patient populations, endoscopic CTR is associated with fewer postoperative complications than open CTR, but is associated with greater expenses.

Cited by 43 publications

References 35 publications

Carpal Tunnel Syndrome: A Review of Literature

Carpal Tunnel Syndrome: A Review of Literature

Serious postoperative complications and reoperation after carpal tunnel decompression surgery in England: a nationwide cohort analysis

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

Contact Info

Product

Resources

About