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Current Trends in Carpal Tunnel Release: A Comparison of Endoscopic and Open Surgical Rates, Outcomes, and Complications between Hand Fellowship and Non-Hand Fellowship Trained Surgeons Utilizing the American Board of Orthopaedic Surgery Certification Exam
Brandon S. Smetana, MD; Xin Zhou, PhD; Shep Hurwitz, MD; Ganesh V. Kamath, MD; J. Megan M. Patterson, MD
University of North Carolina, Chapel Hill, NC

Introduction: This study aimed to investigate the current rates, recent trends, and complications in relation to carpal tunnel surgery and type of fellowship training using the American Board of Orthopaedic Surgery (ABOS) Part II Database.
Materials and Methods: The ABOS database was searched for patients with CTS (ICD-9: 354.0) who underwent carpal tunnel release (CTR) either open (CPT: 64721) or endoscopically (CPT: 29848) from 2003-2013. Cases with multiple CPT codes were excluded. Data was gathered on geographic location, fellowship, and surgical outcomes. Data was then divided into two cohorts based on surgeon level of training: hand fellowship trained versus non-hand fellowship trained. Analysis was performed with Chi-squared tests of independence and for trend.
Results: Overall, 12.4% of all CTR cases were done endoscopically. Hand fellowship trained orthopaedists performed about 4.5 times (18% versus 4%) the number of ECTR than did non-hand fellowship trained surgeons (Figure 1). An increasing trend of ECTR was seen only among the hand fellowship cohort. The Northwest performed the highest (23.1%) and the Southwest the lowest (5.9%) percentage of ECTR (Figure 2). The complication rate associated with CTR overall was 3.56%, with ECTR was 2.83%, and with OCTR was 3.69%, although this was not statistically significant. There was no difference between complication rates with ECTR and OCTR between the two cohorts (Figure 3). However, within the hand fellowship cohort the complication rate for ECTR was significantly less than for OCTR. Wound complications were higher with OCTR and nerve palsy with ECTR, with postoperative pain equivalent between techniques.
Conclusions: The rate of ECTR is increasing, as are reported complications. However, complication rates remain low in the first few years of practice. Hand fellowship trained surgeons perform more ECTR than do non-hand fellowship trained orthopaedic surgeons however there does not seem to be a difference in complication rates between these groups.

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