Consecutive versus simultaneous bilateral carpal tunnel release

Many patients have symptoms of bilateral carpal tunnel syndrome and require surgical release of both hands. Despite the intuitive savings to both the patient and the institution of simultaneous carpal tunnel release, many surgeons choose to repair one hand at a time under the assumption that the morbidity and disability following surgery, such as pain and hand incapacity, would be too great if both hands were repaired simultaneously. We reviewed the charts of 108 patients who underwent bilateral carpal tunnel release to ascertain information on both the relative costs and morbidities of the 2 approaches; mean follow-up time was 2.6 years. With regard to costs, the average number of clinic visits for the simultaneous group was 2 versus 4.5 for the consecutive group (P < 0.0001). The mean total operating room time for the simultaneous group was 48.5 minutes versus 72.5 minutes for the consecutive group (P < 0.0001). The average time off work for the simultaneous group was 3.25 weeks versus 6 weeks for the consecutive group (P = 0.08). To evaluate morbidity, 62 patients consented to telephone interviews regarding the outcome of their surgery, 51 of whom had undergone simultaneous release. Of the 51 patients who underwent simultaneous release, 48 (94%) were satisfied with the overall results of their surgery, and 38 (75%) stated that they would undergo simultaneous release again. All 11 patients in the consecutive group were satisfied with the results of their surgery and would do it again (P = 0.21 and 0.03, respectively). On the basis of these findings, we conclude first, the overall costs associated with simultaneous release are considerably less than consecutive bilateral release, and second, the disability following simultaneous bilateral carpal tunnel release is no greater than that following consecutive bilateral release. We, therefore, recommend simultaneous bilateral carpal tunnel release in patients who have bilateral carpal tunnel syndrome.