A geospatial analysis of open and endoscopic carpal tunnel surgery in the United States

Well-established disparities are limiting the use of carpal tunnel release (CTR). Prior studies have not identified geographic areas with limited use of CTR, nor have they evaluated geographic or socioeconomic differences between open and endoscopic approaches.

A cross-sectional study was conducted using open and endoscopic CTR Medicare data from 2013 through 2022. Moran's I statistic was calculated using geospatial analysis on the county level to determine hotspots (high rates) and coldspots (low rates). Logistic regression determined the socioeconomic factors associated with hotspots (OR>1) or coldspots (OR<1).

The majority of the 1,411,972 patients underwent open surgery (73.9 %). For all CTR, a greater percentage living in a rural community (OR = 0.96, [95 % CI: 0.94, 0.99]; p = 0.0018) was associated with coldspots. For open surgery, a greater percentage living in a rural community (OR = 0.97, [95 % CI: 0.94, 0.99]; p = 0.018) and a greater percentage uninsured (OR = 0.80, [95 % CI: 0.67, 0.96]; p = 0.018) were associated with coldspots. For endoscopic surgery, the percentage of adults with obesity (OR = 0.85, [95 % CI: 0.75, 0.96]; p = 0.0072) was a significant predictor of coldspots.

Significant utilization disparities for both open and endoscopic CTR exist in the Medicare population. Living in a rural environment was the primary determinant of reduced utilization, underscoring the possible need for more hand surgeons in these areas. These findings may be generalizable to CTS care for all ages and insurance statuses.