Evaluation of Racial and Ethnic Differences in Carpal Tunnel Release Surgery
Paul B Walker, BS1, Bryan Aristega Almeida, BA1, Jona Kerluku, BS2, Kevin Lee, BS1, Adriana Urruela, MD2 and Duretti T Fufa, MD2, (1)Weill Cornell Medical College, New York, NY, (2)Hospital for Special Surgery, New York, NY
Disparities in utilization of orthopaedic surgery based on race and ethnicity have been previously documented. We examine the impact of race/ethnicity and insurance status on treatment recommendation by hand surgeon for CTS of similar disease severity.
MATERIALS AND METHODS
Patients with EMG-confirmed CTS at a single institution with 10 hand surgeons treated between 2016-2020 were eligible for inclusion. Patient age, gender, insurance type, and EMG severity were collected. Patient and surgeon race/ethnicity were stratified into four categories: White non-Hispanic, Hispanic/Latino, Black non-Hispanic, and Other. Outcome measures included treatment recommendation (surgical, nonsurgical), treatment completed, and time to treatment.
949 patients met inclusion criteria. Mean age was 58 years old (range 18-80), with 60.5% female (n=574). Race/ethnicity was: 70.3% White non-Hispanic (n=667), 23.8% Hispanic (n=106), 9.8 % Black non-Hispanic (n=93), and 8.7% Other (n=83). Electrodiagnostic severity was mild to moderate in 36.7% (n=348), moderate in 24.3% (n=231), and moderate to severe in 39.0% (n=370). Surgery was recommended in 30.2% (n=105) of patients with mild to moderate CTS, 47.6% (n=110) with moderate CTS, and 61.9% (n=229) with moderate to severe CTS.
Surgeon recommendation for operative treatment was higher for older patients (p<0.01) and for those with more severe electrodiagnostic severity (p<0.01). For all categories of EMG severity, surgeons were more likely to recommend surgery to White non-Hispanic patients than Black non-Hispanic and Latino/Hispanic patients (p<0.01). Additionally, White patients were more likely to undergo surgery (p<0.01) than Black non-Hispanic and Latino/Hispanic patients. There was no correlation between time to surgery and patient race/ethnicity.
Compared to non-White physicians, White physicians treated more patients with private insurance (78.5%, n=215/274) than government insurance (p<0.01). Patients with government insurance were also significantly more likely to have more severe CTS upon initial visit (p<0.01).
Surgeon recommendation for operative management of CTS of similar disease severity correlated with older age and White non-Hispanic race. In spite of presentation with greater electrodiagnostic severity, Black non-Hispanic and Latino/Hispanic patients were less likely to undergo surgery than White non-Hispanic patients following surgical recommendation. Given these findings, greater investigation in to the factors influencing both surgeon and patient selection of treatment for CTS, including the impact of insurance type and patient-surgeon race concordance is warranted.
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