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American Association for Hand Surgery

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Demographic Disparities Amongst Patients Receiving Carpal Tunnel Release: A Retrospective Review of 92,921 Patients
Peter G Brodeur, MA1, Devan D Patel, MD1, Aron H Licht, BA1, David H Loftus, BS1, Aristides I Cruz, Jr., MD, MBA1 and Joseph A Gil, MD2, (1)Alpert Medical School of Brown University, Providence, RI, (2)Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI

Introduction:
Despite strong evidence supporting the efficacy of surgical release for carpal tunnel syndrome (CTS), several epidemiologic and statistical analyses have shown significant disparities amongst which patient population ultimately undergoes surgical intervention. The purpose of this study is to investigate potential socioeconomic disparities in the surgical treatment for CTS.
Materials & Methods:
Adult patients (≥18) were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2011-2018 by International Classification of Diseases 9 and 10 Clinical Modification diagnosis code for CTS. All carpal tunnel surgery procedures in the outpatient setting were identified using CPT codes (64721 and 29848). Using a unique identifier for each patient, the diagnosis data was linked to procedure data. A multivariable logistic regression was performed to assess the impact of patient factors on the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, ethnicity, social deprivation (SDI), Charlson Comorbidity Index (CCI), and primary insurance type.
Results:
92,921 patients with CTS were included in the analysis and 30,043 (32.3%) went on to have surgery. Older age (OR=1.017, p<.0001) and workers compensation compared to private insurance (OR=2.431, p<.0001) had increased odds of surgery. Female sex had lower odds of surgery (OR=0.966, p=0.0334). Asian (OR=0.378, p<.0001), African American (OR=0.434, p<.0001), and Other (OR=0.5, p<.0001) races had decreased odds of surgery relative to White race. Patients of Hispanic ethnicity (OR=0.85, p<.0001) had decreased odds of surgery compared to non-Hispanic ethnicity. Patients with Medicare (OR=0.897, p<.0001), Medicaid (OR=0.816, p<.0001), or self-pay (OR=0.499, p<.0001) insurance were all less likely to undergo surgery relative to private insurance. Higher social deprivation (OR=0.993, p<.0001) was also associated with decreased odds of surgery.
Conclusions:
Carpal tunnel release is associated with disparities among race, ethnicity, sex, primary insurance, and social deprivation. Considering the relationship between differential care and health disparities, it is critical to define the disparities involved and to increase physician awareness to promote appropriate management of CTS.



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