Open carpal tunnel decompression by specialist versus nurse practitioner

Area of Science:

• Surgical outcomes
• Hand surgery
• Healthcare professional roles

Background:

• Carpal tunnel syndrome is a common condition requiring surgical intervention.
• Open carpal tunnel decompression is a standard surgical procedure.
• The role of advanced practice providers, such as nurse practitioners, in surgical procedures is expanding.

Purpose of the Study:

• To compare the clinical outcomes of open carpal tunnel decompression performed by surgical specialists versus nurse practitioners.
• To evaluate differences in surgical time, postoperative pain, and patient satisfaction between the two groups.

Main Methods:

• A retrospective review of 1361 open carpal tunnel decompression cases performed under local anesthesia between 1996 and 2008.
• Data collected included surgical time, total theatre time, postoperative pain, and patient satisfaction.
• Comparison between cases performed by specialists (consultant, specialist registrar, specialty and associate specialist) and a nurse practitioner.

Main Results:

• Specialists had significantly shorter mean surgical times (13 vs. 18 minutes) and total theatre times (26 vs. 29 minutes).
• Postoperative pain rates were higher for specialists (31.5% vs. 24.5%), as was patient dissatisfaction (1.6% vs. 0.18%).
• Since May 2006, outcomes were comparable between specialists and the nurse practitioner, potentially influenced by anesthetic techniques and infiltration methods. Waiting times reduced significantly.

Conclusions:

• Open carpal tunnel decompression yields comparable outcomes when performed by either surgical specialists or nurse practitioners.
• The findings support the expanded role of nurse practitioners in performing certain surgical procedures.
• Improvements in anesthetic protocols may have contributed to comparable outcomes.