American Association for Hand Surgery

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The Flexible Care Pathway: Simplified and Safe Post- Operative Care After Carpal and Cubital Tunnel Release
Lyly Nguyen, MD1, Sydney L Payne, BS2, Ashkan Afshari, MD1 and Brian C Drolet, MD1, (1)Vanderbilt University Medical Center, Nashville, TN, (2)Vanderbilt University, Nashvile, TN



Telehealth, mobile app, and other remote follow-up methods have demonstrated cost reductions and increased patient satisfaction post-operatively compared to Conventional Follow-up (CFU). However, a Flexible Care Pathway (FCP), which involves only “as-needed” follow-up, has never been formally evaluated. We hypothesize that the FCP is a safe and satisfactory pathway for patients who undergo carpal (CTR)/ cubital tunnel release (CuTR).


Materials & Methods:


Preoperatively, veterans who required a CTR and/or CuTR were given the option to enroll in the FCP, in which post-operative follow-up visits were “as-needed” only. Patients who chose CFU were evaluated within 2 weeks post-operatively. Preoperatively, detailed written post-operative instructions were given to and reviewed with patients in both groups, regardless of the pathway chosen. Both groups were contacted by phone 30 days post-operatively with a questionnaire about their care (Appendix 1 & 2). The main outcomes were the number of FCP to CFU conversions (i.e., patients requiring in person evaluation after selecting FCP), complications requiring follow-up, time and distance of patient travel, as well as patient satisfaction.




A total of 94 patients were enrolled in the study, and 58% chose FCP. One quarter (24.4%) of patients in the FCP group converted to in-person clinic evaluation. Of these patients, 11.1% had a complication compared to 18.2% of CFU patients (p=0.51). On average, the CFU group travelled a roundtrip distance of 94.3 miles and expended an estimated 3.5 hours for their follow-up visits. FCP patients would have traveled a greater distance than CFU patients (124.6 vs 94.3 miles, p = 0.04). CFU patients ranked their overall satisfaction at an average of 8.5/10 whereas the FCP group was an average of 9.4/10 (p=0.01).




The Flexible Care Pathway can be safely used in ambulatory hand surgeries such as carpal and cubital tunnel release. Although these results are limited by selection bias, with patients requiring further travel preferring FCP, we found that the FCP demonstrated a higher degree of patient satisfaction and a decrease in patient travel than CFU. This is particularly relevant in geographically broad areas or in a veteran population with less access to specialty care. The Flexible Care Pathway may be applicable to other types of ambulatory surgical procedures and warrants further investigation.



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