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
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Article info
Publication history
Published online: September 08, 2021
Accepted:
July 21,
2021
Received:
July 19,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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