Outcome of Simple Decompression of Primary Cubital Tunnel Syndrome Based on Patient-Reported Outcome Measurements

Mendelaar, Nienke H.A.; Power, Dominic; Blomme, R.A.M.; Sluijter, Berbel J.R.; Avoort, D.J.J.C. van der; Kroeze, A.; Smit, Jeroen M.; Debeij, J.; Walbeehm, Erik T.; Couwelaar, G.M. van; Vermeulen, Guus M.; Schipper, J.P. de; Halbesma, G.J.; Temming, J.F.M.; Uchelen, J.H. van; Boer, H.L. de; Haas, Kirsten; Harmsen, K.; Zöphel, Oliver T.; Feitz, Reinier; Souer, J. Sebastiaan; Koch, Richard S; Hovius, Steven E.R.; Moojen, Thybout M.; Smit, Xander; Bijlsma, Ward R; Colaris, Joost W.; Nieuwenhoven, Christianne A. van; Heijden, Brigitte E.P.A. van der; Hundepool, Caroline A.; Duraku, Liron S.; Zuidam, J. Michiel; Huis, R. van; Pennehouat, P.Y.; Schoneveld, K.; Kooij, Y.E. van; Wouters, Robbert M.; Veltkamp, J.J.; Fink, A. K.; Ridder, W.A. de; Slijper, Harm P.; Selles, Ruud W.; Porsius, Jarry T.; Tsehaie, Jonathan; Poelstra, Ralph; Jansen, Miguel C.; Evers, Stefanie; Oest, Mark J. W. van der; Hoogendam, Lisa; Teunissen, Joris S; Koopman, Jaimy E.; Sun, P.O.; Dekker, Jak; Stege, Marloes H. P. ter; Hagen, R

doi:10.1016/j.jhsa.2021.11.020

Cited by 4 publications

(5 citation statements)

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“…Most patients report symptom improvement after surgical treatment of cubital tunnel syndrome [9, 14, 24]. Information on the effect of surgical procedure or patient demographic characteristics on odds of revision cubital tunnel release would help inform decisions on which surgical procedure to perform and the relative risks and benefits of surgical versus nonsurgical treatment of cubital tunnel syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Information on the effect of surgical procedure or patient demographic characteristics on odds of revision cubital tunnel release would help inform decisions on which surgical procedure to perform and the relative risks and benefits of surgical versus nonsurgical treatment of cubital tunnel syndrome. Prior studies have reported that demographic information, disease characteristics, and medical comorbidities but not surgical procedure are associated with revision cubital tunnel release [5,9,10,14,23,24], but prior work has focused largely on single institutions or included only a single payer. In our allpayer statewide study, we found that the rate of revision cubital tunnel release was lower than reported previously.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients report symptom improvement after surgical treatment of cubital tunnel syndrome [9,14,24].…”

Section: Discussionmentioning

confidence: 99%

“…Outcomes after surgery for cubital tunnel syndrome are generally positive, with most patients reporting symptom improvement postoperatively [9,14,24]. However, some patients have persistent or recurrent symptoms and may undergo revision cubital tunnel release [1,20].…”

Section: Introductionmentioning

confidence: 99%

“…However, some patients have persistent or recurrent symptoms and may undergo revision cubital tunnel release [1,20]. Prior studies have reported that younger age, workers compensation insurance, preoperative opioid use, McGowan Stage I disease, shorter duration of symptoms, and medical comorbidities but not surgical procedure (in situ decompression versus transposition of the ulnar nerve) were associated with revision cubital tunnel release surgery [5,9,10,14,23,24]. However, these findings likely have limited generalizability given their focus on single institutions or single payers.…”

Section: Introductionmentioning

confidence: 99%

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What Factors Are Associated With Revision Cubital Tunnel Release Within 3 Years?

Schloemann

Hammert

Mandalapu

et al. 2023

Clin Orthop Relat Res

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Background It has been shown that patient demographics such as age, payer factors such as insurance type, clinical characteristics such as preoperative opioid use, and disease grade but not surgical procedure are associated with revision surgery to treat cubital tunnel syndrome. However, prior studies evaluating factors associated with revision surgery after primary cubital tunnel release have been relatively small and have involved patients from a single institution or included only a single payer. Questions/purposes (1) What percentage of patients who underwent cubital tunnel release underwent revision within 3 years? (2) What factors are associated with revision cubital tunnel release within 3 years of primary cubital tunnel release? Methods We identified all adult patients who underwent primary cubital tunnel release from January 1, 2011, to December 31, 2017, in the New York Statewide Planning and Research Cooperative System database using Current Procedural Terminology codes. We chose this database because it includes all payers and nearly all facilities in a large geographic area where cubital tunnel release may be performed. We used Current Procedural Terminology modifier codes to determine the laterality of primary and revision procedures. The mean age of the cohort overall was 53 ± 14 years, 43% (8490 of 19,683) were women, and 73% (14,308 of 19,683) were non-Hispanic White. The Statewide Planning and Research Cooperative System database organization does not include a listing of all state residents and thus does not allow for censoring of patients who move out of state. All patients were followed for 3 years. We developed a multivariable hierarchical logistic regression model to model factors independently associated with revision cubital tunnel release within 3 years. Key explanatory variables included age, gender, race or ethnicity, insurance, patient residential location, medical comorbidities, concomitant procedures, whether the procedure was unilateral or bilateral, and year. The model also controlled for facility-level random effects to account for the clustering of observations among these entities. Results The risk of revision cubital tunnel release within 3 years of the primary procedure was 0.7% (141 of 19,683). The median time to revision cubital tunnel release was 448 days (interquartile range 210 to 861 days). After controlling for patient-level covariates and facility random effects, and compared with their respective counterparts, the odds of revision surgery were higher for patients with workers compensation insurance (odds ratio 2.14 [95% confidence interval 1.38 to 3.32]; p < 0.001), a simultaneous bilateral index procedure (OR 12.26 [95% CI 5.93 to 25.32]; p < 0.001), and those who underwent submuscular transposition of the ulnar nerve (OR 2.82 [95% CI 1.35 to 5.89]; p = 0.006). The odds of revision surgery were lower with increasing age (OR 0.79 per 10 years [95% CI 0.69 to 0.91]; p < 0.001) and a concomitant carpal tunnel release (OR 0.66 [95% CI 0.44 to 0.98]; p = 0.04). Conclusion The risk of revision cubital tunnel release was low. Surgeons should be cautious when performing simultaneous bilateral cubital tunnel release and when performing submuscular transposition in the setting of primary cubital tunnel release. Patients with workers compensation insurance should be informed they are at increased odds for undergoing subsequent revision cubital tunnel release within 3 years. Future work may seek to better understand whether these same effects are seen in other populations. Future work might also evaluate how these and other factors such as disease severity could affect functional outcomes and the trajectory of recovery. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%