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Does Patient Demographic and Payer Type Affect Practice Patterns in the Surgical Management of Carpal Tunnel Syndrome?
Donna Mullner, MD1; Reece Moore, BS1; Ashlie A Elver, BS2; H. Todd Hudson, MS1; Fernando Herrera, MD3
1Medical University of South Carolina, Charleston, SC; 2University of Kansas Medical Center, Kansas City, KS; 3Division of Plastic Surgery, Medical University of South Carolina, Division of Plastic Surgery, Charleston, SC

Background: Open Carpal Tunnel Release (OCTR) and Endoscopic Carpal Tunnel Release (ECTR) are the two operative approaches used to treat Carpal Tunnel Syndrome (CTS). This study aims to identify differences between OCTR and ECTR rates and if these differences relate to patient demographics or hospital characteristics.
Methods: The 2018 Nationwide Ambulatory Surgery Sample (NASS) was filtered for patient encounters including either Open or Endoscopic Carpal Tunnel Release operations. All patients undergoing either OCTR or ECTR were included, regardless of treating surgical specialty. Patient demographics and hospital characteristics data were collected and compared between the two treatment groups.
Results: A total of 180,740 patient encounters were collected for both procedure types (OCTR: 62.4% female, mean age 58; ECTR: 62.2% female, mean age 58). Patients from lower income zip codes, low population areas, and Medicare/Medicaid insurance coverage were more likely to undergo OCTR (all p<0.001). In contrast, patients who received care at academic centers and centers with >300 beds were more likely to undergo ECTR (p<0.001). Additionally, ECTR was more costly, with average total charges $1,568 greater than charges for OCTR (p<0.001).
Conclusions: Significant differences exist in treatment strategies for CTS related to patient income, location, and primary payer status. Differences in OCTR and ECTR rates are also present, though modest, as related to size and academic status of hospitals.


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