Purpose
Most randomized trials comparing open carpal tunnel release (OCTR) to endoscopic carpal
tunnel release (ECTR) are not specific to a working population and focus mainly on
how surgical technique has an impact on outcomes. This study’s primary goal was to
evaluate factors affecting days out of work (DOOW) following carpal tunnel release
(CTR) in a working population and to evaluate for differences in medical costs, indemnity
payments, disability ratings, and opioid use between OCTR and ECTR with the intent
of determining whether one or the other surgical method was a determining factor.
Methods
Using the Ohio Bureau of Workers’ Compensation claims database, individuals were identified
who underwent unilateral isolated CTR between 1993 and 2018. We excluded those who
were on total disability, who underwent additional surgery within 6 months of their
index CTR, including contralateral or revision CTR, and those not working during the
same month as their index CTR. Outcomes were evaluated at 6 months after surgery.
Multivariable linear regression was performed to evaluate covariates associated with
DOOW.
Results
Of the 4596 included participants, 569 (12.4%) and 4027 (87.6%) underwent ECTR and
OCTR, respectively. Mean DOOW were 58.4 for participants undergoing OCTR and 56.6
for those undergoing ECTR. Carpal tunnel release technique was not predictive of DOOW.
Net medical costs were 20.7% higher for those undergoing ECTR. Multivariable linear
regression demonstrated the following significant predictors of higher DOOW: preoperative
opioid use, legal representation, labor-intensive occupation, increasing lag time
from injury to filing of a worker’s compensation claim, and female sex. Being married,
higher income community, and working in the public sector were associated with fewer
DOOW.
Conclusions
In a large statewide worker’s compensation population, demographic, occupational,
psychosocial, and litigatory factors have a significant impact on DOOW following CTR,
whereas differences in surgical technique between ECTR and OCTR did not.
Type of study/level of evidence
Therapeutic III.
Key words
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References
- Extended follow-up of a randomized clinical trial of open vs endoscopic release surgery for carpal tunnel syndrome.JAMA. 2015; 314: 1399-1401
- Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials.J Orthop Surg Res. 2015; 10: 12
- Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials.Clin Orthop Relat Res. 2015; 473: 1120-1132
- [Endoscopic operation or conventional open surgical technique in carpal tunnel syndrome: a prospective comparative study].Handchir Mikrochir Plast Chir. 1996; 28: 128-132
- Single-portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial.J Bone Joint Surg Am. 2002; 84: 1107-1115
- The value of one-portal endoscopic carpal tunnel release: a prospective randomized study.Knee Surg Sports Traumatol Arthrosc. 1995; 3: 113-116
- [Agee endoscopic operation of carpal tunnel syndrome in comparison with open surgical technique].Handchir Mikrochir Plast Chir. 1996; 28: 143-146
- Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial.J Hand Surg Br. 2003; 28: 444-449
- Endoscopic carpal tunnel decompression.J Hand Surg Br. 1994; 19: 5-13
- Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods.J Bone Joint Surg Am. 1993; 75: 1265-1275
- [Agee endoscopic decompression of the median nerve: prospective study with comparison to open decompression].Handchir Mikrochir Plast Chir. 1996; 28: 151-155
- Endoscopic release of the carpal tunnel: a randomized prospective multicenter study.J Hand Surg Am. 1992; 17: 987-995
- A tale of two health-care systems: cost-utility analysis of open carpal tunnel release in Canada and the United States.Plast Surg. 2017; 25: 7-13
- Preoperative opioid use: a risk factor for poor return to work status after single-level cervical fusion for radiculopathy in a workers' compensation setting.Clin Spine Surg. 2018; 31: e19-e24
- Preoperative opioid use is a predictor of poor return to work in workers' compensation patients after lumbar diskectomy.Spine. 2018; 43: 594-602
- Long-term outcomes of lumbar fusion among workers' compensation subjects: a historical cohort study.Spine. 2011 F; 36: 320-331
- Vertebroplasty and return to work for thoracolumbar fractures within the workers' compensation population.Spine. 2017; 42: 1024-1030
- Shorter time to surgery is associated with better outcomes for spondylolisthesis in the workers' compensation population.Orthopedics. 2020; 19: 1-7
- Return to work after diskogenic fusion in workers' compensation subjects.Orthopedics. 2015; 38: e1065-e1072
- Clinical depression is a strong predictor of poor lumbar fusion outcomes among workers' compensation subjects.Spine. 2015; 40: 748-756
- Multilevel lumbar fusion is a risk factor for lower return to work rates among workers' compensation subjects with degenerative disc disease.J Surg Orthop Adv. 2018; 27: 209-218
- Lumbar discography is associated with poor return to work status following lumbar fusion surgery in a workers' compensation setting.J Surg Orthop Adv. 2018; 27: 25-32
- Decompression versus decompression and fusion for degenerative lumbar stenosis in a workers' compensation setting.Spine. 2017; 42: 1017-1023
- The timing of surgery affects return to work rates in patients with degenerative lumbar stenosis in a workers' compensation setting.Clin Spine Surg. 2017; 30: e1444-e1449
- Prolonged preoperative opioid therapy in patients with degenerative lumbar stenosis in a workers' compensation setting.Spine. 2017; 42: e1140-e1146
- Treatment of recurrent lumbar disc herniation with or without fusion in workers' compensation subjects.Spine. 2017; 42: e864-e870
- Neck pain, preoperative opioids, and functionality after cervical fusion.Orthopedics. 2017; 40: 25-32
- Return to work and multilevel versus single-level cervical fusion for radiculopathy in a workers' compensation setting.Spine. 2017; 42: e111-e116
- Prolonged preoperative opioid therapy associated with poor return to work rates after single-level cervical fusion for radiculopathy for patients receiving workers' compensation benefits.Spine. 2017; 42: e104-e110
- Lumbar diskography and failed back syndrome in patients receiving workers' compensation.Orthopedics. 2015; 38: e951-e958
- Displaced femoral neck fractures in workers' compensation patients aged 45-65 years: is it best to fix the fracture or replace the joint?.J Arthroplasty. 2020; 35: 3195-3203
- Simultaneous bilateral or unilateral carpal tunnel release? a prospective cohort sudy of early outcomes and limitations.J Bone Joint Surg Am. 2014; 96: 889-896
- Health status, work limitations, and return-to-work trajectories in injured workers with musculoskeletal disorders.Qual Life Res. 2007; 16: 1167-1178
- Contested claims in carpal tunnel surgery: outcome study of worker's compensation factors.Iowa Orthop J. 1999; 19: 111-121
- Consumer price index.
- 2013-2017 American community survey five-year estimates.https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2017/5-year.htmlDate: 2017Date accessed: October 10, 2020
- Chronic opioid therapy after lumbar fusion surgery for degenerative disc disease in a workers' compensation setting.Spine. 2015; 40: 1775-1784
- Effects of baseline opioid medication use on patient-reported functional and psychological impairment among hand clinic patients.J Hand Surg Am. 2019; 44: 829-839
- Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials.BMC Musculoskelet Disord. 2020; 21: 272
- Early results of conventional versus two-portal endoscopic carpal tunnel release. A prospective study.J Hand Surg Br. 1995; 20: 658-662
- Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment.J Bone Joint Surg Br. 2002; 84 (April): 375-379
- [Carpal tunnel syndrome. Can it still be a controversial topic?].Chirurgie. 1993; 119: 80-84
- [Surgical treatment of carpal tunnel syndrome: endoscopic or classical (open)? A prospective randomized trial].Ned Tijdschr Geneeskd. 1997; 141: 878-882
- A prospective, randomized study with an independent observer comparing open carpal tunnel release with endoscopic carpal tunnel release.J Hand Surg Br. 1996; 21: 202-204
- Endoscopic versus open carpal tunnel release: a randomized trial.J Hand Surg Am. 2003; 28: 475-480
- Endoscopic and open release similarly safe for the treatment of carpal tunnel syndrome. A systematic review and meta-analysis.PLoS One. 2015; 10e0143683
- Endoscopic versus open carpal tunnel release: a detailed analysis using time-driven activity-based costing at an academic medical center.J Hand Surg Am. 2019; 44: 62 e1-62e9
- Cost implications of varying the surgical technique, surgical setting, and anesthesia type for carpal tunnel release surgery.J Hand Surg Am. 2018; 43: 971-977.e1
- Surgical approach and anesthetic modality for carpal tunnel release: a nationwide database study with health care cost implications.Hand. 2017; 12: 162-167
- Optimizing costs and outcomes for carpal tunnel release surgery: a cost-effectiveness analysis from societal and health-care system perspectives.J Bone Joint Surg Am. 2021; 103: 2190-2199
- Open versus endoscopic carpal tunnel release: a decision analysis.J Hand Surg Am. 1999; 24: 1109-1117
- Predictors of return to work following carpal tunnel release.Am J Ind Med. 1997; 31: 85-91
- Determinants of return to work after carpal tunnel release.J Hand Surg Am. 2012; 37: 18-27
- Prognostic factors for return-to-work following surgery for carpal tunnel syndrome: a systematic review.JBI Database System Rev Implement Rep. 2016; 14: 135-216
- Prognostic variables for patient return-to-work interval following carpal tunnel release in a workers' compensation population.Hand. 2017; 12: 246-251
- Cost-minimization analysis of open and endoscopic carpal tunnel release.J Bone Joint Surg Am. 2016; 98: 1970-1977
- Candidate quality measures for hand surgery.J Hand Surg Am. 2017; 42: 859-866 e3
- Management of carpal tunnel syndrome: evidence-based clinical practice guideline.https://www.aaos.org/globalassets/quality-and-practice-resources/carpal-tunnel/cts-cpg_4-25-19.pdfDate accessed: February 29, 2016
- Does workers' compensation status affect outcomes after lumbar spine surgery? A systematic review and meta-analysis.Int J Environ Res Public Health. 2021; 18: 6165
- Influence of workers' compensation status on postoperative outcomes in patients following biceps tenodesis: a matched-pair cohort analysis.J Shoulder Elbow Surg. 2020; 29: 2530-2537
- Spine surgery outcomes in workers' compensation patients.J Am Acad Orthop Surg. 2017; 25: e225-e234
- Outcomes after hip arthroscopy in patients with workers' compensation claims.Orthopedics. 2015; 38: e94-e98
- Workers' compensation claims and outcomes after reverse shoulder arthroplasty.J Shoulder Elbow Surg. 2015; 24: 453-459
- Workers' compensation and outcomes of upper extremity surgery.J Am Acad Orthop Surg. 2013; 21: 67-77
- Workers' compensation patients after total joint arthroplasty: do they return to work?.J Arthroplasty. 2013; 28: 883-887
- Outcomes following carpal tunnel release in patients receiving workers' compensation: a systematic review.Hand. 2018; 13: 137-142
- How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.Spine J. 2014; 14: 1237-1246
- Return to work rates after single-level cervical fusion for degenerative disc disease compared with fusion for radiculopathy in a workers' compensation setting.Spine. 2016; 41: 1160-1166
- Workers' compensation, return to work, and lumbar fusion for spondylolisthesis.Orthopedics. 2016; 39: e1-e8
- Single-level lumbar fusion for degenerative disc disease is associated with worse outcomes compared with fusion for spondylolisthesis in a workers' compensation setting.Spine. 2015 1; 40: 323-331
- Validation of an administrative coding algorithm for classifying surgical indication and operative features of spine surgery.Spine. 2015; 40: 114-120
- Accuracy of VA databases for diagnoses of knee replacement and hip replacement.Osteoarthritis Cartilage. 2010; 18: 1639-1642
Article info
Publication history
Published online: April 25, 2022
Accepted:
February 16,
2022
Received:
May 14,
2021
Footnotes
No benefits in any form have been received or will be received directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
