Comparison of Surgeon Expectations to Patient-Reported Outcomes Following Open Carpal Tunnel Release

Open carpal tunnel release (OCTR) is an effective surgical treatment option for carpal tunnel syndrome (CTS). This study evaluates hand surgeon expectations of postoperative recovery versus patient-reported outcomes following OCTR through Patient-Reported Outcomes Measurement Information System (PROMIS) surveys.

Patients who underwent OCTR (Common Procedure Terminology 64721) for CTS performed by 5 hand surgeons were evaluated (2021-2024). PROMIS pain-interference (P-PI) and pain-upper extremity (P-UE) surveys were completed at 2-week, 6-week, and 3-month intervals postoperatively. Patients who underwent simultaneous hand procedures with OCTR and/or had perioperative complications were excluded. Hand surgeons completed PROMIS P-PI and P-UE surveys for theoretical patient groups to predict postoperative recovery in the same timeframe. Higher P-PI scores suggest greater pain, and higher P-UE scores suggest better functionality.

Sixty-eight patients were included. Among patients with minimal comorbidities/mild CTS (n = 33), surgeons predicted less pain (P-PI = 38.7 vs 54.8, P = .004) and better functionality (P-UE = 59.8 vs 35.5, P = .00005) compared to mean patient scores at 3 months postoperatively. For patients with multiple comorbidities/mild CTS (n = 17), surgeons predicted less pain (P-PI = 40.7 vs 52.7, P = .013) and better function (P-UE = 53.0 vs 41.3, P = .034) at 3 months postoperatively. In the same cohort, surgeons predicted better function at 2 weeks postoperatively (P-UE = 30.4 vs 36.2, P = .032). For severe CTS patients (n = 18), surgeons predicted less pain (P-PI = 45.6 vs 54.3, P = .009) and better function (P-UE = 37.9 vs 28.5, P = .047) at 6 weeks postoperatively.

Hand surgeons may be overly optimistic about recovery timelines for patients undergoing OCTR, specifically underestimating how pain may interfere with daily tasks and their upper-extremity function at 3 months postoperatively.