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Trends in Open and Endoscopic Carpal Tunnel Release: Medicare Projections Through 2040
Paul G. Mastrokostas, BA, BBA
1, Mohamed Said, MA
1, Alejandro J. Friedman, MA
1,2, Leonidas E. Mastrokostas, BA
1, Scott Liu, MD
1, Katherine M. Connors, MD
1; Jennifer Hashem, MD
1(1)SUNY Downstate Health Sciences University, Brooklyn, NY, (2)Montefiore Medical Center, Bronx, NY
Introduction: Carpal tunnel release (CTR) is one of the most commonly performed hand surgeries, with both open and endoscopic techniques widely utilized. This study analyzes historical trends in CTR utilization among Medicare beneficiaries and projects future procedural volumes through 2040.
Materials and Methods: Medicare Part B National Summary data from 2000 to 2022 were used to estimate annual procedural volumes for open (CPT 64721) and endoscopic (CPT 29848) CTR. Adjustments were made to account for the increasing proportion of Medicare Advantage enrollees. Four forecasting models-log-linear, Poisson regression, negative binomial regression, and auto-regressive integrated moving average (ARIMA)-were applied. Model performance was evaluated using mean absolute error and root mean square error, with ARIMA selected for its superior predictive accuracy.
Results: From 2000 to 2022, the annual volume of open CTR increased by 180%, while endoscopic CTR grew by 959%. ARIMA projections indicate that open CTR will continue to grow at an average annual rate of 2.0%, reaching an estimated 424,271 procedures by 2040. Endoscopic CTR is projected to increase at a faster rate of 2.42% annually, with a forecasted volume of 184,723 by 2040. Despite this growth, open CTR is expected to remain the predominant approach.
Conclusions: CTR utilization has increased substantially, with endoscopic techniques growing at a faster rate than open CTR. Despite this trend, open CTR is projected to remain the predominant approach. Future research should assess the economic impact, patient-reported outcomes, and factors influencing the adoption of each technique.
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