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Timing of Carpal Tunnel Syndrome Treatment Based on Social Deprivation
Akhil Dondapati, MD
1; Callista N Zaronias, BA
2; Janet N Tran, BA
2; Cody Fowler, MD
2; Thomas J Carroll, MD
1; Bilal Mahmood, MD
21University of Rochester Medical Center, Rochester, NY; 2University of Rochester, Rochester, NY
Introduction: Studies have shown increased levels of social deprivation to be correlated with worse outcomes in the treatment of many orthopedic conditions. The Area Deprivation Index (ADI) measures social deprivation using several domains based on zip codes. A correlation between increased social deprivation and delays in the treatment timeline for carpal tunnel syndrome (CTS) has not been established. The purpose of this study was to investigate the impact of ADI on the treatment timeline for CTS to carpal tunnel release (CTR). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery.
Methods: This is a retrospective review of patients diagnosed with CTS who underwent CTR at a single academic institution. Patients were chosen by random selection. Variables including gender, race, ethnicity, smoking status, medical comorbidities, ADI, timing of visits and surgery, and electrodiagnostic (EDX) studies were collected. Analysis included univariate chi-square tests and ANOVA, as well as multivariate linear and logistic regressions.
Results: Five hundred and one patients were divided by ADI national percentiles from least to most deprived tertiles. Univariate analysis demonstrated significantly increased time from EDX to CTR comparing the least and most deprived tertiles (52 days vs. 95 days, p=0.022). On multivariate analysis, this correlation was no longer significant (p=0.066). Multivariate analysis also revealed a non-significant trend (p=0.068) towards higher ADI correlating with a trial of corticosteroid injections. Corticosteroid injections prior to surgery correlated with an increased time from EDX to CTR (p<0.001) and time from initial presentation to CTR (p<0.001). A diagnosis of severe CTS on EDX correlated with a significantly decreased likelihood of corticosteroid injections (p=0.006). EDX being completed prior to presentation expedited care from presentation to surgery (p<0.001).
Conclusions: Although previous studies have demonstrated mixed outcome results in CTS, we found that social deprivation does not correlate with delays in the treatment timeline. Factors other than delays in the treatment timeline may be contributing to the potential worse outcomes in CTS patient populations with greater social deprivation.
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