Surgical treatment for carpal tunnel syndrome more cost-effective than nonoperative care

CHICAGO — A study presented at the 63rd Annual Meeting of the American Society for Surgery of the Hand, here, has found that surgical treatment for confirmed carpal tunnel syndrome can be more cost-effective than nonoperative care.

“Carpal tunnel syndrome is one of the most common hand disorders,” said Jay F. Pomerance, MD, of Arlington Heights, Ill. “There are many different treatment options all with varying levels of cost.”

To find the most cost-effective treatment, Pomerance and colleague Ilene S. Fine retrospectively reviewed 120 patients (average age, 50 years) who were divided into two equal groups that were either treated nonoperatively with splinting and 2 weeks of hand therapy or underwent surgery.

Patients had their diagnosis of carpal tunnel syndrome confirmed through nerve conduction studies, Pomerance said.

The groups were matched for severity of nerve conduction abnormalities, age, gender, body mass index, smoking history, medical history, job category and insurance coverage. All patients had a minimum follow-up of 1 year.

“Injections were available but not mandated, and patients were allowed to crossover if they felt that the nonoperative treatment was insufficient to control symptoms,” Pomerance said.

The surgical group underwent short-incision open carpal tunnel release.

Variables measured included cost of care, measured through quality-of-life adjusted years and outcomes via the Michigan Hand Outcomes Questionnaire (MHQ).

“Approximately half of the nonoperative group crossed over to surgical treatment,” Pomerance said.

A multivariate logistic regression analysis found that 96% of healthy patients with moderate to severe nerve conduction studies crossed into the surgical group.

A comparison of the cost between the groups initially showed that nonoperative care was cheaper. However, “The costs rapidly ramped up when those patients crossed over into the surgery group,” Pomerance said.

The cost of care averaged $2,322 +/- $975/person in the nonoperative group, $3,068 +/- $983/person in the surgical group, and $4,221 +/- $1,113/person for the crossover group.

The MHQ scores averaged 60 +/- 8 for the nonoperative and operative groups pretreatment. After treatments, the scores were 57 +/- 8 for the nonoperative group, 76 +/- 6 (range 69-82) for the operative group, and 74 +/- 7 for the crossover group.

No patient in the nonoperative group was symptom-free at final follow up, he said.

Pomerance said there is limited evidence to show that nonoperative treatment is effective in the current literature, “and when it is used, it deteriorates over time.”

For more information:
Pomerance JF, Fine IS. Direct cost analysis in matched patient groups comparing operative and nonoperative care in carpal tunnel syndrome. Paper 36. Presented at the 63rd Annual Meeting of the American Society for Surgery of the Hand. Sept. 18-20, 2008. Chicago.