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Simultaneous carpal tunnel release more cost-effective than staged release
Study finds similar patient satisfaction rates between those treated with simultaneous vs. staged surgery.
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WASHINGTON — Simultaneous bilateral carpal tunnel release surgery produces similar patient satisfaction rates compared with staged procedures, according to a study presented here. Simultaneous bilateral surgery was also associated with significantly lower direct costs and a faster return to work for the patient, one of the study authors noted.
Peter J. Stern, MD, and colleagues at the Hand Surgery Center in Cincinnati studied 113 patients who underwent bilateral carpal tunnel release (CTR) at the center from April 2001 to April 2002. Surgeons performed staged procedures in 61 patients and simultaneous procedures in 52 patients. Stephen Hamilton, a medical student, presented the results at the American Society for Surgery of the Hand 61st Annual Meeting.
The researchers retrospectively reviewed patients' charts to determine direct costs — including reimbursement charges for the surgeon, the facility, anesthesia and operating room time — and indirect costs, such as time lost from work, office visits, medication and hand therapy. They also conducted a telephone questionnaire with 85% of the patients to determine their satisfaction. All patients had at least 1 year follow-up.
Compared to the staged CTR, simultaneous CTR was associated with significantly lower average direct costs: $1,864 vs. $2,897 (P<.01). Additionally, simultaneous CTR patients missed an average of 21 days of work, while staged CTR patients missed an average of 40 days (P<.01), Hamilton said.
Simultaneous CTR patients also visited the office significantly less, with an average of three office visits vs. five for staged CTR patients (P<.01), according to the study.
"Reimbursement was less for the simultaneous group compared to the staged group due to one facility fee, one anesthesia fee and there was decreased physician reimbursement, despite equal charges," Hamilton said.
Based on the telephone questionnaires, researchers found an equal patient satisfaction rate between the two groups. No patients required professional home care, but almost all relied on family members — an additional cost not analyzed in the study, Hamilton said.
For more information:
- Zannis J, Hamilton S, Stern PJ. Staged vs. simultaneous bilateral open carpal tunnel release: Analysis of cost and patient satisfaction. #15. Presented at the American Society for Surgery of the Hand 61st Annual Meeting. Sept. 7-9, 2006. Washington.