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Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
Published on: January 11, 2019
Utilization of Preoperative Electrodiagnostic Studies for Carpal Tunnel Syndrome: An Analysis of National Practice
Erika D Sears1, Peter R Swiatek2, Hechuan Hou3
1Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Purpose:
Given the lack of a reference standard diagnostic tool for carpal tunnel syndrome (CTS), we conducted a population-level analysis of patients undergoing carpal tunnel release to characterize the utilization of preoperative electrodiagnostic studies (EDS). Secondarily, we sought to determine the impact of EDS utilization on timeliness of surgery, number of preoperative physician visits, and costs.
Methods:
The 2009-2013 Truven MarketScan databases were used to identify a national cohort of adult patients undergoing carpal tunnel release. Three multivariable regression models were designed to evaluate the relationship between preoperative EDS use and timing of surgical release, the number of preoperative physician visits, and total costs for CTS-related visits, while controlling for sociodemographic variables, insurance type, comorbid conditions, and treatment characteristics.
Results:
The final study cohort included 62,894 patients who underwent carpal tunnel release, of whom 58% had preoperative EDS. Patients undergoing EDS waited 36% longer for surgical release than patients without EDS. The mean time between diagnosis and surgery was predicted to be 183 days for patients who underwent preoperative EDS and 135 days for patients who did not. Patients having EDS experienced 1 additional visit, $996 greater total costs, and $112 additional out-of-pocket costs on average. Occupational therapy consultation and steroid injection were also associated with increased time to surgery, but with one-fourth and one-third the added cost of EDS, respectively.
Conclusions:
On the basis of national practice trends, providers do not consistently agree with the practice of performing EDS before carpal tunnel release. Given the uncertain utility of routine EDS before carpal tunnel release and its association with delays to surgery and increased costs, further evaluation of EDS in relation to patient preferences and value of care is warranted.
Type Of Study/Level Of Evidence:
Prognostic II.
