Out-Of-Pocket Expenses of Carpal Tunnel Release

Out-of-pocket charges (OOPCs) are growing faster than the total cost of care. Carpal tunnel release (CTR) is performed in variable surgical settings under different anesthetic protocols. OOPC of CTR may impact patient choice and patient perception of the value of their insurance. The primary objective of this study was to identify factors associated with OOPC after CTR.

We retrospectively identified patients who underwent CTR between January 1, 2019, and November 4, 2022 by three hand surgeons at a tertiary referral center in the Northeast United States. The final cohort comprised 808 patients. OOPC was defined as surgical and anesthesia fees billed to the patient for CTR surgery following primary and secondary insurance payment. Multivariable logistic regression analysis was performed to identify explanatory variables independently associated with our response variables.

The mean age of the final cohort was 61.7 years, with 66% women, 79% White, and 100% insured. The multivariable logistic regression analysis showed protective factors against OOPC after CTR included Hispanic ethnicity and diabetes mellitus. Risk factors for having OOPC included no secondary insurance, procedure in a minor procedure room, and out-of-state residence.

As overall health care costs balloon, patients are bearing more financial responsibility for care. Our results may aid surgeons in shared decision-making discussions about modifiable surgical choices such as surgical setting and anesthesia choice.Type of study/level of evidence: Economic Analysis IV.