Advertisement

The Preoperative Cost of Carpal Tunnel Syndrome

Published:September 08, 2021DOI:https://doi.org/10.1016/j.jhsa.2021.07.027

      Purpose

      Carpal tunnel syndrome is a common condition, with well-defined diagnostic and treatment guidelines. Despite these guidelines, continued variation in care exists, with providers variably using diagnostic tests and nonsurgical treatment modalities prior to surgery. The purpose of this study was to evaluate the variation and cost associated with the diagnosis and nonsurgical treatment of patients prior to undergoing carpal tunnel release.

      Methods

      We queried the Truven MarketScan database to identify patients who underwent carpal tunnel release from 2010 to 2017. Patients were identified using common current procedural terminology codes and included if they were enrolled in the database for a minimum of 12 months prior to surgery to allow all preoperative data to be captured. All associated current procedural terminology codes during the 1-year preoperative period were refined to codes related to median neuropathy and categorized as office visits, diagnostic imaging (x-ray, ultrasound, and magnetic resonance imaging), electrodiagnostic testing, injections, occupational or physical therapy, durable medical equipment, and preoperative laboratory tests.

      Results

      In total, 378,381 patients were included in the study. A per-patient average cost of $858.74 was spent on preoperative workup and nonsurgical treatment. Electrodiagnostic testing represented 44.6% of the cost, and office visits represented 31.9%. Regarding nonsurgical treatment, 16.1% of the patients received an injection during the 1-year preoperative period, 26.8% received a medical brace, and 6.6% used physical therapy. When analyzed based on age group, the per-patient average cost for patients aged 70 years or older was significantly less than those younger than 70 years ($723.92 vs $878.76).

      Conclusions

      Despite robust clinical practice guidelines and high volumes, significant variation in presurgical care exists. These data are useful to begin to critically analyze the causes of variation in the diagnosis and treatment of carpal tunnel syndrome and move toward a more effective, efficient, and informed treatment strategy.

      Type of study/level of evidence

      Economic/decision analysis II.

      Key words

      JHS Podcast

      August 2, 2022

      Perspectives - August 2022

      Listen to Dr. Chris Grandizio's perspective on the article "The Preoperative Cost of Carpal Tunnel Syndrome" by Greenfield et al, that appears in the August 2022 issue of the Journal of Hand Surgery.

      Loading ...
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Padua L.
        • Coraci D.
        • Erra C.
        • et al.
        Carpal tunnel syndrome: clinical features, diagnosis, and management.
        Lancet Neurol. 2016; 15: 1273-1284
      1. Practice parameter for carpal tunnel syndrome (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 1993; 43: 2406-2409
        • Atroshi I.
        • Gummesson C.
        • Johnsson R.
        • Ornstein E.
        • Ranstam J.
        • Rosen I.
        Prevalence of carpal tunnel syndrome in a general population.
        JAMA. 1999; 282: 153-158
        • Mondelli M.
        • Giannini F.
        • Giacchi M.
        Carpal tunnel syndrome incidence in a general population.
        Neurology. 2002; 58: 289-294
        • Bland J.D.
        • Rudolfer S.M.
        Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001.
        Neurology. 2003; 74: 1674-1679
        • Newington L.
        • Harris E.C.
        • Walker-Bone K.
        Carpal tunnel syndrome and work.
        Best Pract Res Clin Rheumatol. 2015; 29: 440-453
        • Fajardo M.
        • Kim S.H.
        • Szabo R.M.
        Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting.
        J Hand Surg. 2012; 37: 1599-1605
        • Cima R.R.
        • Lackore K.A.
        • Nehring S.A.
        • et al.
        How best to measure surgical quality? Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution.
        Surgery. 2011; 150: 943-949
        • Palmer D.H.
        • Hanrahan L.P.
        Social and economic costs of carpal tunnel surgery.
        Instr Course Lect. 1995; 44: 167-172
        • Akkurt M.O.
        • Düzgün S.
        • Ateş A.
        • Yaradılmış Y.U.
        Comparison of two approaches for carpal tunnel release: extended versus mini-open technique.
        Jt Dis Relat Surg. 2020; 31: 50-55
        • Karl J.W.
        • Gancarczyk S.M.
        • Strauch R.J.
        Complications of carpal tunnel release.
        Orthop Clin North Am. 2016; 47: 425-433
        • Li Y.
        • Luo W.
        • Wu G.
        • Cui S.
        • Zhang Z.
        • Gu X.
        Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials.
        BMC Musculoskelet Disord. 2020; 21: 1-6
        • Billig J.I.
        • Sears E.D.
        • Gunaseelan V.
        • et al.
        Inappropriate preoperative gabapentinoid use among patients with carpal tunnel syndrome.
        J Hand Surg. 2020; 45: 677-689
        • Lu Y.T.
        • Deol A.K.
        • Sears E.D.
        The association between electrodiagnostic severity and treatment recommendations for carpal tunnel syndrome.
        J Hand Surg. 2020; 46: 92-98
        • Lu Y.T.
        • Haase S.C.
        • Chung T.T.
        • Chung K.C.
        • Sears E.D.
        The impact of pre-referral advanced diagnostic testing on wait time to see a hand surgeon for common upper-extremity conditions.
        J Hand Surg. 2019; 44: 1013-1020
        • Sears E.D.
        • Lu Y.T.
        • Wood S.M.
        • et al.
        Diagnostic testing requested before surgical evaluation for carpal tunnel syndrome.
        J Hand Surg. 2017; 42: 623-629
        • Sears E.D.
        • Meerwijk E.L.
        • Schmidt E.M.
        • et al.
        Variation in nonsurgical services for carpal tunnel syndrome across a large integrated health care system.
        J Hand Surg. 2019; 44: 85-92
        • Harris A.H.
        • Meerwijk E.L.
        • Ding Q.
        • et al.
        Testing proposed quality measures for treatment of carpal tunnel syndrome: feasibility, magnitude of quality gaps, and reliability.
        BMC Health Serv Res. 2020; 20: 1-8
        • Genova A.
        • Dix O.
        • Saefan A.
        • Thakur M.
        • Hassan A.
        • et al.
        Carpal tunnel syndrome: a review of literature.
        Cureus. 2020; 12e7333
        • Verdugo R.J.
        • Salinas R.A.
        • Castillo J.L.
        • Cea G.
        Surgical versus non-surgical treatment for carpal tunnel syndrome.
        Cochrane Database Syst Rev. 2008; CD001552
        • Goz V.
        • Rane A.
        • Abtahi A.M.
        • Lawrence B.D.
        • Brodke D.S.
        • Spiker W.R.
        Geographic variations in the cost of spine surgery.
        Spine. 2015; 40: 1380-1389
        • Kozma C.M.
        • Meletiche D.M.
        • Phillips A.L.
        The effect of age and sex on cost of inpatient facility encounters among patients with multiple sclerosis.
        J Med Econ. 2015; 18: 704-710
        • Mundell B.F.
        • Gates M.J.
        • Kerezoudis P.
        • et al.
        Does patient selection account for the perceived cost savings in outpatient spine surgery? A meta-analysis of current evidence and analysis from an administrative database.
        J Neurosurg Spine. 2018; 29: 687-695
        • Sheyn D.
        • Mahajan S.
        • Billow M.
        • Fleary A.
        • Hayashi E.
        • El-Nashar S.A.
        Geographic variance of cost associated with hysterectomy.
        Obstet Gynecol. 2017; 129: 844-853
        • Sayari A.J.
        • Tuchman A.
        • Cohen J.R.
        • Hsieh P.C.
        • Buser Z.
        • Wang J.C.
        Risk and cost of reoperation after single-level posterior cervical foraminotomy: a large database study.
        Global Spine J. 2017; 7: 116-122
        • Daffner S.D.
        • Beimesch C.F.
        • Wang J.C.
        Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis.
        Spine (Phila Pa 1976). 2010; 35: 1165-1169
        • Shi Q.
        • Bobos P.
        • Lalone E.A.
        • Warren L.
        • MacDermid J.C.
        Comparison of the short-term and long-term effects of surgery and nonsurgical intervention in treating carpal tunnel syndrome: a systematic review and meta-analysis.
        HAND. 2020; 15: 13-22
        • Graham B.
        • Peljovich A.E.
        • Afra R.
        • et al.
        The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome.
        J Bone Joint Surg Am. 2016; 98: 1750-1754
        • Billig J.I.
        • Nasser J.S.
        • Chen J.S.
        • et al.
        Comparison of safety and insurance payments for minor hand procedures across operative settings.
        JAMA Netw Open. 2020; 3e2015951
        • Inui A.
        • Suzuki T.
        • Kokubu T.
        • Sakata R.
        • Mifune Y.
        • Kurosaka M.
        Carpal tunnel syndrome caused by tumoral calcinosis.
        Case Rep Orthop. 2015; 2015: 170873
        • Nakamichi K.I.
        • Tachibana S.
        • Tamai K.
        Carpal tunnel syndrome caused by a mass of calcium phosphate.
        J Hand Surg. 1994; 19: 111-113
        • Takada T.
        • Fujioka H.
        • Mizuno K.
        Carpal tunnel syndrome caused by an idiopathic calcified mass.
        Arch Orthop Trauma Surg. 2000; 120: 226-227
        • Concannon M.J.
        • Gainor B.
        • Petroski G.F.
        • Puckett C.L.
        The predictive value of electrodiagnostic studies in carpal tunnel syndrome.
        Plast Reconstr Surg. 1997; 100: 1452-1458
        • Glowacki K.A.
        • Breen C.J.
        • Sachar K.
        • Weiss A.P.
        Electrodiagnostic testing and carpal tunnel release outcome.
        J Hand Surg Am. 1996; 21: 117-121
        • Graham B.
        The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome.
        J Bone Joint Surg. 2008; 90: 2587-2593
        • De Krom M.C.
        • Knipschild P.G.
        • Spaans F.
        • Kester A.D.
        Efficacy of provocative tests for diagnosis of carpal tunnel syndrome.
        Lancet. 1990; 335: 393-395
        • Jablecki C.K.
        • Andary M.T.
        • Floeter M.K.
        • et al.
        Practice parameter: electrodiagnostic studies in carpal tunnel syndrome: report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation.
        Neurology. 2002; 58: 1589-1592
        • Sears E.D.
        • Swiatek P.R.
        • Hou H.
        • Chung K.C.
        Utilization of preoperative electrodiagnostic studies for carpal tunnel syndrome: an analysis of national practice patterns.
        J Hand Surg. 2016; 41: 665-672
        • Crijns T.J.
        • Ring D.
        • Leung N.
        • et al.
        Feasibility of quality measures for the diagnosis and treatment of carpal tunnel syndrome.
        J Hand Surg. 2020; 45: 813-819