Predictive Factors Associated with the Need for Simultaneous Carpal and Cubital Tunnel Release
Corey C Spencer, MD1, William O Runge, MD2, John T Hurt, BS2, Alex Dawes, BS1, Roy Toston, BS3, Eric R. Wagner, MD2 and Michael Gottschalk, MD4, (1)Emory University School of Medicine, Atlanta, GA, (2)Emory University, Atlanta, GA, (3)Emory University School Medicine, Atlanta, GA, (4)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA
Introduction: Carpal and cubital tunnel syndrome are the most common upper extremity compressive neuropathies treated by hand surgeons. The aim of this study is to determine demographic factors and comorbidities that can help predict those patients most likely to undergo concurrent release of both the carpal and cubital tunnel. We hypothesize that certain comorbidities, such as diabetes, are associated with an increased risk for the necessity of concomitant procedures.
Methods: Using Truven Marketscan® database, all patients who underwent carpal tunnel release from 2010 to 2017 were identified using Current Procedural Terminology (CPT) codes. Patients were included if they had continuous enrollment in the database for 12 months preoperatively. Preoperative comorbidities and concurrent procedures were collected using CPT and ICD-9/10 codes. Patients who underwent simultaneous carpal tunnel and cubital tunnel release on the same day were compared to those patients who underwent carpal tunnel release alone. Additionally, patients who underwent either carpal or cubital tunnel release initially and went on to have the other procedure at a later date were compared. Univariate analysis and binomial logistic regression were performed to assess the contribution of patient demographics and comorbidities on the necessity of simultaneous release.
Results: 259,574 patients underwent carpal tunnel release and were included. 24,401 (7.9%) also underwent simultaneous cubital tunnel release on the same day. Significant risk factors associated with the need for simultaneous release of both carpal and cubital tunnel syndrome, were male gender (OR: 2.05), chronic pain (OR: 1.78), diabetes (OR: 1.29), history of alcoholism (OR: 1.23), chronic renal disease (OR: 1.26), tobacco use (OR: 1.49), and patients with congestive heart failure (OR: 1.26). Patients with consumer driven health plans and high deductible health plans (HDHP) were 1.5 times more likely to have simultaneous release compared to those with comprehensive plans (OR: 1.46; OR: 1.45; respectively). For necessity of subsequent carpal or cubital tunnel release after either primary procedure, patients with a minimum of 3 years enrollment in the database were analyzed. Of 113,505 patients who underwent initial carpal tunnel release, 1,746 (1.5%) required release of the cubital tunnel. Of 12,673 patients who had initial cubital tunnel release, 721 (5.7%) required release of the carpal tunnel.
Conclusion: Identification of patient factors that help predict the likelihood of simultaneous release of both carpal and cubital tunnel syndrome can help direct management of these patients. Combining the two procedures can save resources, minimize patient burden, and reduce excess healthcare utilization.
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