Evaluation of Patient Expectations before Carpal Tunnel Release

Abstract

Background: Carpal tunnel release (CTR) is common, yet patient treatment expectations remain unclear. The primary purpose was to describe patient expectations before CTR. Secondarily, we aimed to identify factors influencing expectations. Methods: Included patients underwent unilateral or bilateral CTR between 2015 and 2017 at a single academic center. Expectations regarding the level of relief/improvement were queried. Area deprivation index (ADI) was used to measure social deprivation. Univariate and multivariable logistic regression identified factors associated with expecting great relief/improvement. Results: Of 307 included patients, mean age was 54 ± 16 years and 63% were women. Patients most commonly expected great (58%) or some (23%) relief/improvement. Few patients expected little (3%) or no (4%) relief/improvement, and 13% had no expectations. In the multivariable analysis, male sex, lower social deprivation, and lower BMI were associated with expecting great relief/improvement. Age, surgical technique (open versus endoscopic), use of the operating room versus procedure room, and preoperative factors (constant numbness, weakness/atrophy, duration of symptoms, and QuickDASH) were not associated with expectations. Conclusions: Most patients expect some to great improvement after CTR. This was independent of several factors with a known association with worse outcomes (advanced age, atrophy/weakness, and constant numbness). Male sex was associated with the expectation of great improvement, in which superior outcomes relative to females have not been borne out in the literature. These findings highlight patient counseling opportunities. The observed association between social deprivation and expectations warrants further investigation, as the socioeconomically disadvantaged experience worse healthcare outcomes in general.

Patient Expectations for Symptomatic Improvement before Cubital Tunnel Release

“…Rogers et al found that male gender, lower BMI, and lower social deprivation correlated with significantly increased expectations before carpal tunnel release. 34 While our univariable analysis did identify employment, revision CuTR, lower levels of social deprivation, and type of insurance (Medicare, Medicaid) as associated with expecting great relief/improvement, the multivariable analysis highlighted a significant increase in expectations before CuTR, specifically in patients with Medicare and Medicaid. This is concerning given that surgical outcomes have been found to be significantly worse in the Medicaid and Medicare populations.…”

“…22 Additionally, specific to hand surgery, lower social deprivation has been associated with greater expectations for improvement after carpal tunnel release. 34 The ADI evaluates 17 factors that influence socioeconomic status, including education level, income, and housing type for a given 9 digit zip code, 35 which is granular to the level of 10-20 homes on average. 36 These data were originally collected from census records based on the Health Resources and Services Administration, and are updated regularly to include the most recent American Community Survey data.…”

“…Specifically, we investigated which preoperative factors were associated with patients expecting great relief/improvement, versus lower levels of expectations (binning of patients with no expectations and those expecting some, little, and no relief/improvement) as previously done. 34 The multivariable model included all variables with a P value less than 0.1 in the univariable analysis. Variance inflation factors were calculated to examine potential multicollinearity of the multivariable model.…”