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American Association for Hand Surgery

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Socioeconomic Status Affects Postoperative Two-Point Discrimination Following Carpal Tunnel Release
Gautham Prabhakar, MD1, Abdullah N Ghali, BS1, David Momtaz, BS, MPH1, Loc-uyen Vo, MD2 and Ryan Adam Rose, MD1, (1)UTHSCSA, San Antonio, TX, (2)UT San Antonio, San antonio, TX

INTRODUCTION
Carpal tunnel release is a life changing procedure within hand surgery. Multiple factors may have an impact on the outcome following surgery. Studies evaluating socioeconomic factors and quantitative measures of symptom severity in Carpal Tunnel Syndrome, such as two-point discrimination (2PD) are limited. High 2PD has been shown to be associated with decreased hand function and sensibility. The hypothesis of this study was to determine whether medical comorbidities and insurance status affect postoperative two point discrimination.
METHODS
We retrospectively reviewed all patients who underwent carpal tunnel release in our institutional database from 2018-2020. All patients between 18 and 90 yrs with a minimum of six week follow-up were included. The primary outcome of interest was to assess differences in preoperative and postoperative two point discrimination scores based on insurance status. Patient demographics were identified, as well as insurance status (ie having Mediciad/Carelink vs commericial), and various comorbidities. Patients were categorized as "improved" or "not improved" based on the difference in their two point tests. Results were tallied and analyzed with Fisher's Exact test to examine the significance between the various associations studied. For the analysis of the preoperative score we ran a logistic regression model to analyze the relationship between income status (operationalized by having Medicaid/Carelink) and preoperative scores, inferential statistics was computed with appropriate t tests.
RESULTS
Of the 126 patients who met the inclusion criteria 47 (37%) had Medicaid or Carelink and 79 (63%) had commercial insurance. Medicaid/Carelink patients presented with higher two point discrimination on initial presentation (p < .017). Compared to commercial insurance, Medicaid/Carelink patients were less likely to show improvement in postoperative two point discrimination (p < 0.05). In addition, male patients were also less likely to show improvement. Medical comorbidities and an age greater than 60 were not shown to have a significant effect on postoperative two point discrimination.
CONCLUSION
Two point discrimination is an accepted tool in assessing postoperative success. Medical comorbidities and insurance status have been demonstrated to have an effect on surgical outcome in the orthopaedic literature. While medical comorbidities did not have a significant effect on postoperative two point, patients with low income status (Medicaid/Carelink) may have a less predictable outcome. These socioeconomic considerations are critical in appropriately risk stratifying surgical candidates and counseling patients that tactile acuity may be less predictable.


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