Guidelines and Policies as Levers in Managing Carpal Tunnel Release Demand

National guidelines and health policy measures can influence both demand for and delivery of elective surgery as well as the setting in which procedures are performed. Carpal tunnel release (CTR), one of the most common elective operations, provides a useful case for examining these effects. This study addresses 2 key research objectives: 1) the evaluation of the impact of Finland's 2007 guideline requiring preoperative electromyoneurography on CTR incidence trends and 2) the assessment of trends in the adoption of procedural room (PR) surgery in university hospitals.

We used Finnish National Hospital Discharge Register (NHDR) data to identify all CTR procedures between 1997 and 2021. The years 2020 to 2021 were excluded due to the COVID-19 pandemic. Negative binomial regression models with population offset were used to estimate annual changes in incidence, adjusted for age and sex. Age- and sex-standardized incidence rates were calculated using direct standardization. Pre- and postguideline period analyses were performed. University hospital records (2017-2025) were analyzed to determine the rates of PR-based CTR.

Between 1997 and 2019, 181,552 CTR procedures were performed in Finland. The age- and sex-standardized incidence increased from 91.9 to 233 per 100,000 person-years. From 1997 to 2007, the incidence of CTR increased by 7.5% annually (P < 0.001), whereas after the 2007 guideline, the increase slowed to 1.2% annually (P < 0.001). From 2017 to 2025, 4 of 5 Finnish university hospitals shifted most CTR operations from operating theaters to PRs, demonstrating rapid institution-level adaptation.

The 2007 national guideline was associated with a marked reduction in CTR incidence growth. The move to PR-based CTR in university hospitals illustrates a high-impact policy strategy for reducing costs, reallocating operating theater capacity, and promoting more sustainable surgical care.