Cost, Value, and Patient Satisfaction in Carpal Tunnel Surgery

Ingram, Joseph; Mauck, Benjamin M.; Thompson, Norfleet B.; Calandruccio, James H.

doi:10.1016/j.ocl.2018.06.005

Cited by 14 publications

(12 citation statements)

References 37 publications

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“…8 We found that 13% of patients in our study were unsatisfied or very unsatisfied with the results of their surgery. A moderately strong positive correlation was identified between patient reported satisfaction and symptom resolution in our study, this finding is supports other research that have correlated patient reported satisfaction and symptom resolution 9,11 and demonstrates unsurprisingly that symptom resolution is an important factor in determining postoperative patient satisfaction.…”

Section: Discussionsupporting

confidence: 91%

Outcome of carpal tunnel decompression with pre-surgical diagnosis determined on general practitioner assessment and nerve conduction study

Matsis

Chou

Clode

2021

Journal of Clinical Orthopaedics and Trauma

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Background: Accurate diagnosis of carpal tunnel syndrome is key to successful treatment. At our center a treatment pathway was recently established for patients with carpal tunnel syndrome. Within this pathway patients are assessed by their community practitioner. Patients who fail to improve with conservative treatment and have a positive nerve conduction study are put forward for surgery without a specialist assessment. Recent literature has shown nerve conduction study may produce a high rate of false-positive results when used to diagnose carpal tunnel syndrome. The aim of this study was to retrospectively review outcomes of carpal tunnel decompression surgery in patients whose diagnoses was based on a community practitioner assessment and positive nerve conduction study. Methods: All patients who had carpal tunnel release surgery between August 1, 2017 and August 31, 2018 at our center were screened for eligibility. Data from hospital records and a standardized telephone questionnaire was used to assess surgical outcome. Results: The final study population included 128 operated hands. The mean follow up time after surgery was 9.6 months. We found 79% of patients reported significant improvement of their symptoms following carpal tunnel release. The overall complication rate was 2.3%. Conclusion:This study has demonstrated good outcomes from carpal tunnel decompressive surgery are possible in a cohort of patients whose diagnosis was made on the basis of a positive nerve conduction study and community practitioner assessment.

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Section: Discussionsupporting

confidence: 91%

Outcome of carpal tunnel decompression with pre-surgical diagnosis determined on general practitioner assessment and nerve conduction study

Matsis

Chou

Clode

2021

Journal of Clinical Orthopaedics and Trauma

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“…3,9,11,13,14 When interpreted together, our finding of equivalent outcomes, combined with prior reports of cost-savings and low complication rates associated with the PR setting, suggests that the value of care for patients undergoing open CTR is greater in the PR setting than in the operating room. 18 Several limitations of our study merit discussion. Our results were derived from 5 surgeons at a single academic institution; therefore, the ability to generalize the results to other practices deserves consideration.…”

Section: Discussionmentioning

confidence: 89%

“…Combining this finding with previous literature demonstrating the reduced cost of the PR compared with the operating room, performing open CTR in the PR has the potential to increase the value of care delivered to indicated patients. 18 * According to the TOST. We conclude that there was equivalence between the PR and operating room for both FSS and SSS because the 90% CIs are within the specified margins.…”

Section: Discussionmentioning

confidence: 99%

“…4,9,12e14 From these studies and additional studies evaluating the cost savings of other hand surgeries performed with wide-awake local anesthesia no tourniquet, 15e17 it is clear that moving hand surgeries from the operating room into the PR has the potential to improve the value of care offered to patients by reducing costs. 18 It is less clear, however whether long-term patient-reported outcomes differ between patients treated in the PR setting versus those treated in the operating room after CTR. White et al 9 demonstrated no difference in postoperative pain scores in patients treated with CTR surgery in the clinic versus the operating room.…”

mentioning

confidence: 99%

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A Comparison of Open Carpal Tunnel Release Outcomes Between Procedure Room and Operating Room Settings

Stephens

Tyser

Presson

et al. 2021

Journal of Hand Surgery Global Online

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Purpose: Carpal tunnel release (CTR) surgical costs are minimized when performed in the procedure room (PR) setting, compared with the operating room. However, it remains unclear whether outcomes differ between surgical settings. Our purpose was to compare outcomes at 1 year or greater follow-up after open CTR between patients treated in PR versus operating room settings using the Boston Carpal Tunnel Questionnaire (BCTQ). Methods: A change in clinical care protocols at our institution occurred in 2014. Before this, all CTRs were performed in the operating room; thereafter, these were transitioned to the PR. Adult patients who underwent isolated unilateral or bilateral open CTR in either surgical setting were considered for inclusion, in which procedures were conducted between January 2014 and October 2018 for the PR group and January 2009 and March 2014 for the operating room group. The Functional Status Scale (FSS) and the Symptom Severity Scale (SSS) components of the BCTQ were collected for all eligible patients at a minimum of 1 year after surgery. We used univariate and multivariable linear regression to determine whether postoperative BCTQ scores were equivalent between PR and operating room groups within a threshold of one-fourth of the lowest estimates of the minimal clinically important difference. Results: No differences in demographics, comorbidities, or insurance type were observed between the 104 PR and 112 operating room patients. Survey response rate was 25% and 25% for the PR and operating room patients, respectively. At a mean follow-up of 3 ± 1 years, FSS and SSS scores were equivalent between PR and operating room groups on bivariate analysis. The multivariable equivalence test also demonstrated equivalent FSS and SSS scores between PR and operating room groups within a one-fourth minimal clinically important difference threshold while controlling for age, sex, presence of diabetes or thyroid disease, unilateral versus bilateral CTR, and surgeon. Conclusions: Clinical outcomes did not differ between PR and operating room settings after open CTR. Type of study/level of evidence: Therapeutic III.

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“…Carpal tunnel syndrome (CTS) is a common condition, 3,[11][12][13][14][15][16][17][18][19][20] with about 600 000 carpal tunnel release (CTR) procedures accounting for more than $2 billion annually in the United States. 3,[11][12][13][16][17][18][19]21,22 In England, between 2014 and 2015, 54 000 surgical decompressions of the carpal tunnel were performed at a cost of £46 million (a little over $58 million) to the National Health Service (NHS) and are predicted to increase 2-fold by 2030. 15 Multiple studies have been conducted about the costeffectiveness of the different treatment methods, showing trends that nonoperative treatments are a relatively inexpensive means to reduce symptoms in the short term, but CTR appears to be, both in clinical outcomes and in cost-effectiveness, better in the long term.…”

mentioning

confidence: 99%

Does Societal Cost Information Affect Patient Decision-Making in Carpal Tunnel Syndrome? A Randomized Controlled Trial

Kortlever

Zhuang

Ring

et al. 2019

Hand (New York, N,Y.)

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Background: Despite studies demonstrating the effects of out-of-pocket costs on decision-making, the effect of societal cost information on patient decision-making is unknown. Given the considerable societal impact of cost of care for carpal tunnel syndrome (CTS), providing societal cost data to patients with CTS could affect decision-making and provide a strategy for reducing national health care costs. Therefore, we assessed the following hypotheses: (1) there is no difference in treatment choice (surgery vs no surgery) in a hypothetical case of mild CTS between patients randomized to receive societal cost information compared with those who did not receive this information; (2) there are no factors (eg, sex, experience with a previous diagnosis of CTS, or receiving societal cost information) independently associated with the choice for surgery; and (3) there is no difference in attitudes toward health care costs between patients choosing surgery and those who did not. Methods: In this randomized controlled trial using a hypothetical scenario, we prospectively enrolled 184 new and return patients with a nontraumatic upper extremity diagnosis. We recorded patient demographics, treatment choice in the hypothetical case of mild CTS, and their attitudes toward health care costs. Results: Treatment choice was not affected by receiving societal cost information. None of the demographic or illness factors assessed were independently associated with the choice for surgery. Patients declining surgery felt more strongly that doctors should consider their out-of-pocket costs when making recommendations. Conclusions: Providing societal cost information does not seem to affect decision-making and may not reduce the overall health care costs. For patients with CTS, health policy could nudge toward better resource utilization and finding the best care pathways for nonoperative and invasive treatments.

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Cost, Value, and Patient Satisfaction in Carpal Tunnel Surgery

Cited by 14 publications

References 37 publications

Outcome of carpal tunnel decompression with pre-surgical diagnosis determined on general practitioner assessment and nerve conduction study

Outcome of carpal tunnel decompression with pre-surgical diagnosis determined on general practitioner assessment and nerve conduction study

A Comparison of Open Carpal Tunnel Release Outcomes Between Procedure Room and Operating Room Settings

Does Societal Cost Information Affect Patient Decision-Making in Carpal Tunnel Syndrome? A Randomized Controlled Trial

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