American Association for Hand Surgery
Theme: Beyond Innovation

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The Critical Portions Of Carpal Tunnel Surgery: A Comparison Between Opinions Of Surgeons And The General Public
Tyler S. Pidgeon, MD1; Alexander Lauder, MD1; Betty C. Tong, MD1; Marc J. Richard, MD1; Suhail K. Mithani, MD2
1Duke University Medical Center, Durham, NC, 2Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC

Background:
The American College of Surgeons require that a teaching surgeon be present for "key and critical" portions of a surgical procedure and have qualified assistance for any non-critical portions. Recent events popularized by news media have questioned operating room (OR) workflow, potentially affecting OR efficiency and surgical trainee graduated responsibility necessary to prepare for independence upon completion of training. The purpose of this study was to compare preferences of surgeons to those of the general public regarding what constitutes the critical portions of carpal tunnel surgery (CTS), and which steps are appropriate for trainees to perform.
Methods:
A survey was devised inquiring about appropriateness of surgical trainee execution of each step of CTS (scale: 1-5). A group of surgeons who perform CTS were queried (n=112). The survey was subsequently modified systematically. First, language was simplified and educational passages to teach respondents without medical training about OR workflow, surgical training, and CTS were added. Second, preliminary responses from a test group of 25 respondents using the MTurk online survey platform (Amazon, Inc.) were used to improve survey clarity. The finalized survey was sent to 225 respondents via MTurk. Responses were excluded if respondents (1) selected having a career in health care (n=35) or (2) completed the survey faster than one standard deviation from the mean (n=11).
Results:
Responses from 32 surgeons (32/112, 29% response) were compared to those of 179 non-medical respondents. 94% (n=30) of surgeons completed hand fellowship training, 53% (n=17) regularly worked with trainees (academic or academic affiliation), and 53% (n=17) utilized concurrent ORs. Non-medical respondent average age was 36 years, 40% were female (71/179), and all regions of the United States as well as a variety of socioeconomic and ethnic groups were represented. Salient findings are outlined in Figures 1-2.
Conclusions:
Contrary to media suggestion, surgeons are significantly more stringent regarding surgical trainee independence performing carpal tunnel surgical steps than the general public. Surgeons who regularly work with trainees are more accepting of trainee involvement performing surgical steps than those who do not. These findings may help guide hospital policies regarding concomitant surgery and trainee graduated independence.
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