Carpal tunnel decompression in primary care: what is the infection risk and is it safe and effective?

The demand for elective hand surgery in England is predicted to double by 2030 compared with 2011. With such increase in demand, the UK must seek strategies to reduce costs of treatment while still maintaining standards of care. Carpal tunnel decompression performed in a treatment room rather than in theatre may provide a safe alternative setting. As yet, there are no UK-based studies that identify the risk of infection following surgery performed in a treatment room and there are no studies whatsoever assessing the qualitative outcomes of patients undergoing hand surgery outside a theatre environment. Our aim was to assess whether carpal tunnel decompression performed in the community is safe, in terms of infection risk, and effective.

Patient outcome measures were prospectively recorded following carpal tunnel decompression in one single primary care centre performed by one surgeon from 2012 to 2017. Infection following surgery was evaluated for retrospectively.

A total of 460 patients underwent carpal tunnel decompression within the study time period. There were three superficial infections identified, giving an infection rate of 0.65%. There were no deep infections identified. There was a statistically significant improvement in both symptom and functional outcomes following surgery, with results comparable to other studies where surgery was performed in theatre.

We believe that carpal tunnel decompressions performed in a treatment room is both safe, in terms of infection risk, and effective. Surgeons should consider this location as an alternative setting to the main operating theatre.