A 2016 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline (CPG) de-emphasized the need for electrodiagnostic studies (EDS) for carpal tunnel syndrome (CTS). We tested the hypothesis that use of EDS decreased after the AAOS CPG.
Using a national administrative claims database, we measured the proportion of patients with a diagnosis of CTS who underwent EDS within 1 year after diagnosis between 2011 and 2019. Using an interrupted time series design, we defined 2 time periods (pre-CPG and post-CPG) and compared EDS usage between the periods using segmented regression analysis. We conducted a subgroup analysis of preoperative EDS usage in patients who underwent carpal tunnel release.
Of 2,081,829 patients with CTS, 315,449 (15.2%) underwent EDS within 1 year after diagnosis. The segmented regression analysis showed a decrease in the level of EDS usage after publication of the AAOS CPG (−11.50 per 1,000 patients [95% CI, −1.47 to −0.95 per 1,000 patients]); however, the rate of EDS usage increased in the post-CPG period (+1.75 per 1,000 patients per quarter [95% CI, 0.97–2.54 per 1,000 patients per quarter]). Of 473,753 eligible patients who underwent carpal tunnel release, 139,186 (29.4%) underwent EDS within 6 months before surgery. After publication of the AAOS CPG, preoperative EDS usage decreased by −23.57 per 1,000 patients (95% CI, −37.72 to −9.42 per 1,000 patients). However, these decreasing trends in EDS usage predated the 2016 AAOS CPG.
The overall and preoperative EDS usage for CTS has been decreasing since at least 2014, predating the 2016 AAOS CPG, reflecting the rapid implementation of evidence into practice. However, EDS usage has increased in the post-CPG period, and a considerable proportion of patients who underwent carpal tunnel release still received EDS.
Given its high costs and disputed value, routine EDS usage should be considered for further deimplementation initiatives.
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Published online: November 29, 2022
Accepted: September 21, 2022
Received: April 27, 2022
The institution of Dr Kamal has received, during the study period, funding from an Orthopaedic Research and Education Foundation Mentored Clinician Scientist Grant and National Institutes of Health (number K23AR073307-01). No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
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