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Variation in Surgeons' Requests for General Anesthesia When Scheduling Carpal Tunnel Release
Alex H S Harris1,2, Esther L Meerwijk1, Robin N Kamal2
1VA Palo Alto Health Care System, Menlo Park, CA, USA.
Hand (New York, N.Y.)
|February 22, 2019
Summary
Surgeon and facility factors, not patient characteristics, significantly influence general anesthesia requests for carpal tunnel release (CTR). Routine use of general anesthesia for CTR should be reconsidered in clinical guidelines.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Health Services Research
Background:
- Carpal tunnel release (CTR) offers various anesthesia options.
- General anesthesia for CTR presents higher risks and resource use, questioning its routine application.
Purpose of the Study:
- To investigate patient factors linked to general anesthesia requests for CTR.
- To determine the frequency of general anesthesia use by Veterans Health Administration (VHA) surgeons and facilities.
Main Methods:
- Analysis of national VHA data from fiscal years 2015 and 2017 for CTR procedures.
- Mixed-effects logistic regression to assess patient, procedure, and surgeon influences on anesthesia choice.
Main Results:
- 18,145 CTRs were analyzed; 12.2% involved general anesthesia.
- Patient, procedure, and surgeon factors showed some association with reduced general anesthesia requests.
- Significant variability in general anesthesia use existed across surgeons and facilities, with some requesting it for over 75% of patients.
Conclusions:
- Anesthesia choice for CTR is more dependent on the performing facility and surgeon than patient-specific factors.
- Recommendations include reconsidering routine general anesthesia for CTR in clinical practice guidelines and quality metrics.