Background Carpal tunnel release (CTR) is among the most common hand surgeries, although little is known about its pattern. In this study, we aimed to investigate temporal trends, age and gender variation and current practice patterns in CTR surgeries. Methods We conducted a population-based time series analysis among over 13 million residents of Ontario, who underwent operative management for carpal tunnel syndrome (CTS) from April 1, 1992 to March 31, 2010 using administrative claims data. Results The primary analysis revealed a fairly stable procedure rate of approximately 10 patients per 10,000 population per year receiving CTRs without any significant, consistent temporal trend (p = 0.94). Secondary analyses revealed different trends in procedure rates according to age. The annual procedure rate among those age >75 years increased from 22 per 10,000 population at the beginning of the study period to over 26 patients per 10,000 population (p<0.01) by the end of the study period. CTR surgical procedures were approximately two-fold more common among females relative to males (64.9% vs. 35.1 respectively; p<0.01). Lastly, CTR procedures are increasingly being conducted in the outpatient setting while procedures in the inpatient setting have been declining steadily – the proportion of procedures performed in the outpatient setting increased from 13% to over 30% by 2010 (p<0.01). Conclusion Overall, CTR surgical-procedures are conducted at a rate of approximately 10 patients per 10,000 population annually with significant variation with respect to age and gender. CTR surgical procedures in ambulatory-care facilities may soon outpace procedure rates in the in-hospital setting.
References
[1]
Kerwin G, Williams CS, Seiler JG 3rd (1996) The pathophysiology of carpal tunnel syndrome. Hand Clin 12: 243–251.
[2]
Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, et al. (1998) Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 88: 1447–1451. doi: 10.2105/ajph.88.10.1447
[3]
Szabo RM, Steinberg DR (1994) Nerve entrapment syndromes in the wrist. J Am Acad Orthop Surg 2: 115–123.
[4]
Katz JN, Stirrat CR, Larson MG, Fossel AH, Eaton HM, et al. (1990) A self-administered hand symptom diagram for the diagnosis and epidemiologic study of carpal tunnel syndrome. J Rheumatol 17: 1495–1498.
[5]
Atroshi I, Gummersson C, Johnsson R, Ornstein E, Ranstam J, et al. (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 282: 153–158. doi: 10.1001/jama.282.2.153
[6]
Bernard B (1997) A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. Cincinnati: Centers for Disease Control and Prevention National Institute for Occupational Safety and Health publication. 97–141.
[7]
Spinner RJ, Bachman JW, Amadio PC (1989) The many faces of carpal tunnel syndrome. Mayo Clin Proc 64: 829–836. doi: 10.1016/s0025-6196(12)61756-x
[8]
Katims JJ, Rouvelas P, Sadler B, Weseley SA (1989) Current Perception Threshold: Reproducibility and comparison with nerve conduction in evaluation of carpal tunnel syndrome. ASIO Trans 35: 280–284. doi: 10.1097/00002480-198907000-00034
[9]
Bland JDP, Rudolfer SM (2003) Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry 74: 1674–1679. doi: 10.1136/jnnp.74.12.1674
[10]
deKrom M, Kester A, Knipschild P (1992) Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 45: 373–376. doi: 10.1016/0895-4356(92)90038-o
Concannon MJ, Brownfield ML, Puckett CL (2000) The incidence of recurrence after endoscopic carpal tunnel release. Plas Reconstr Surg 105: 1662–1665. doi: 10.1097/00006534-200004050-00010
[13]
Levine DW, Simmons BP, Koris MJ, Daltory LH, Hohl GG, et al. (1993) A Self-Administered Questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 75: 1585–1592.
[14]
Palmer DH, Hanrahan LP (1995) Social and economic costs of carpal tunnel surgery. Instr Course Lect 44: 167–172.
[15]
Mondelli M, Giannini F, Giacchi M (2002) Carpal tunnel syndrome incidence in a general population. Neurology 58: 289–294. doi: 10.1212/wnl.58.2.289
[16]
Liss GM, Armstrong C, Kusiak RA, Gailitis MM (1992) Use of provincial health insurance plan billing data to estimate carpal tunnel syndrome morbidity and surgery rates. Am J Ind Med 22: 395–409. doi: 10.1002/ajim.4700220312
[17]
Carpal Tunnel Surgery. Health Care Blue Book website. Available: http://healthcarebluebook.com/page_Resul？ts.aspx?id=2&dataset=hosp. Accessed 2012 Jul 12.
[18]
Leblanc M, Lalonde J, Lalonde D (2007) A Detailed Cost and Efficiency Analysis of Performing Carpal Tunnel Surgery in the Main Operating Room versus the Ambulatory Setting in Canada. Hand 2: 173–178. doi: 10.1007/s11552-007-9043-5
Al-Omran M, Tu JV, Johnston KW, Mamdani MM (2003) KuceyDS (2003) Use of interventional procedures for peripheral arterial occlusive disease in Ontario between 1991 and 1998: a population-based study. J Vasc Surg 38: 289–295. doi: 10.1016/s0741-5214(03)00273-8
[21]
Bell CM, Bajcar J, Bierman AS, Li P, Mamdani MM, et al. (2006) Potentially unintended discontinuation of long-term medication use after elective surgical procedures. Arch Intern Med 166: 2525–2531. doi: 10.1001/archinte.166.22.2525
[22]
Ontario Ministry of Health (1992) Schedule of benefits: physician services under the Health Insurance Act; 1992.
[23]
Pindyck RS, Rubinfeld DL (1998) Econometric models and economic forecasts. New York: Irwin McGraw-Hill 463–601.
[24]
Fajardo M, Kim SH, Szabo RM (2012) Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting. J Hand Surg Am 37: 1599–1605. doi: 10.1016/j.jhsa.2012.04.035
[25]
Roh YH, Chung MS, Baek GH, Lee YH, Rhee SH, et al. (2010) Incidence of clinically diagnosed and surgically treated carpal tunnel syndrome in Korea. J Hand Surg 35: 1410–1417. doi: 10.1016/j.jhsa.2010.05.020
[26]
Stevens JC, Sun S, Beard CM, O’Fallon WM, Kurland LT (1988) Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 38: 134–138. doi: 10.1212/wnl.38.1.134
[27]
Latinovic R, Gulliford MC, Hughes RA (2006) Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry 77: 263–265. doi: 10.1136/jnnp.2005.066696
American Academy of Orthopaedic Surgeons clinical practice guideline on Diagnosis of Carpal Tunnel Syndrome (2007). Available: http://www.aaos.org/Research/guidelines/？CTS_guideline.pdf.
[30]
Graham B (2008) The value added by electro-diagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am 90: 2587–2593. doi: 10.2106/jbjs.g.01362
