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American Association for Hand Surgery

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Evaluation of Patient Expectations prior to Carpal Tunnel Release
Miranda J. Rogers, MD, MS1, Dustin J. Randall, BS2, Jayden N. Brennan, BS1, Chong Zhang, MS3, Angela P. Presson, PhD3 and Nikolas H. Kazmers, MD MSE1, (1)University of Utah, Salt Lake City, UT, (2)Oakland University William Beaumont School of Medicine, Rochester, MN, (3)Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT

Hypothesis: The relationship between preoperative patient expectations, satisfaction, and outcome score improvement is nuanced. Our primary purpose was to describe patient preoperative expectations prior to carpal tunnel release (CTR). Secondarily, we aimed to identify factors influencing expectations among CTR patients.
Methods: We retrospectively reviewed adult patients undergoing isolated unilateral or bilateral CTR performed by 1 of 5 fellowship-trained orthopaedic hand surgeons at a tertiary academic medical center between 2015 and 2017. Patient expectations were queried within 3 months prior to CTR ("How much relief and/or improvement seems realistic to you as a result of the treatment you will be receiving?"), with responses including "Great relief/improvement", "Some relief/improvement", "Little relief/improvement", "No relief/improvement", and "I do not have any expectations". Manual chart review was performed to collect potential predictor variables, verify coded procedures, and to ensure the expectations question was answered at a preoperative visit pertaining to CTR surgery. The 2015 Area Deprivation Index (ADI) was used to measure social deprivation. Univariate and multivariable binary logistic regression ("Great relief/improvement" was compared to binning of the other 4 levels) was used to identify factors associated with expectations.
Results: Of 307 included patients, mean age was 54 16 years and 63% were female (Table 1). Patients most commonly expected great (58%) or some (23%) improvement (Table 1). In the univariate analysis, surgical technique (open versus endoscopic CTR), surgical setting (procedure room versus OR), preoperative presence of constant numbness or atrophy/weakness, and level of preoperative upper extremity disability (QuickDASH) were not associated with expectations (Table 2). In the multivariable analysis, only the following predictors were significantly associated with higher expectations: male sex, lower social deprivation, and lower BMI (Table 2). Specifically, males had 87% greater odds of expecting great improvement than females. Each 1-point increase in BMI and 1-percentile increase in ADI/social deprivation were associated with a 3% and 2% decreased odds in expecting great improvement, respectively.
Summary Points:

  • The majority of patients expect some to great improvement after CTR. This was independent of surgical technique and surgical setting.
  • Older age, constant numbness, and presence of weakness/atrophy do not influence patient expectation, highlighting an opportunity for patient counseling as these factors are associated with less improvement and greater likelihood of residual symptoms after CTR.
  • Our finding that social deprivation is associated with lower expectations is consistent with a plethora of data demonstrating worse outcomes and decreased access to healthcare for the socioeconomically disadvantaged.


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