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Abstract

Background:

The annual volume of carpal tunnel release (CTR) in the United States has been estimated to be 577 000 per year. Our objectives were to evaluate the incidence and risk factors for revision CTR within 1 year of primary CTR.

Methods:

We identified all adult patients undergoing primary CTR from October 2015 to September 2019 in the New York Statewide Planning and Research Cooperative System database using Current Procedural Terminology (CPT) codes. We used the CPT modifier codes to determine laterality of index and revision procedures. We estimated multivariable hierarchical logistic regression models to evaluate risk factors for revision CTR within 1 year.

Results:

Of the 80 423 primary CTR procedures, 178 (0.22%) underwent a revision CTR within 1 year of the index surgery. The mean (SD) age of the entire cohort was 58.69 (14.43) years, 61.1% were women, 73.2% were non-Hispanic white, 42.9% were covered through private insurance, and 9.5% had diabetes mellitus. Workers’ compensation insurance (odds ratio [OR] = 1.83, 95% confidence interval [CI], 1.13-2.98, P = .02) and simultaneous bilateral CTR (OR = 14.91, 95% CI, 9.62-23.12, P < .001) were associated with revision CTR within 1 year of the index procedure. No models demonstrated an association between endoscopic technique or surgeon volume and revision CTR.

Conclusions:

The incidence of revision CTR within 1 year was lower than that previously reported. Patients covered by workers’ compensation and those undergoing simultaneous bilateral CTR had higher likelihood of a revision CTR within 1 year, whereas endoscopic technique and surgeon volume were not associated with revision CTR within 1 year.

Keywords

revision carpal tunnel release incidence of revision carpal tunnel carpal tunnel syndrome nerve diagnosis carpal tunnel treatment

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References

Dale

Harris-Adamson

Rempel

, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Heal. 2013;39(5):495-505. doi:10.5271/sjweh.3351.

Mondelli

Giannini

Giacchi

. Carpal tunnel syndrome incidence in a general population. Neurology. 2002;58:289-294.

Fajardo

Kim

Szabo

. Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting. J Hand Surg Am. 2012;37(8):1599-1605. doi:10.1016/j.jhsa.2012.04.035.

Pourmemari

Heliövaara

Viikari-Juntura

, et al. Carpal tunnel release: lifetime prevalence, annual incidence, and risk factors. Muscle Nerve. 2018;58(4):497-502. doi:10.1002/mus.26145.

Neuhaus

Christoforou

Cheriyan

, et al. Evaluation and treatment of failed carpal tunnel release. Orthop Clin North Am. 2012;43(4):439-447. doi:10.1016/j.ocl.2012.07.013.

Westenberg

Oflazoglu

De Planque

, et al. Revision carpal tunnel release: risk factors and rate of secondary surgery. Plast Reconstr Surg. 2020;145(5):1204-1214. doi:10.1097/PRS.0000000000006742.

Lane

JCE

Craig

Rees

, et al. Serious postoperative complications and reoperation after carpal tunnel decompression surgery in England: a nationwide cohort analysis. Lancet Rheumatol. 2021;3(1):e49-e57. doi:10.1016/S2665-9913(20)30238-1.

Wessel

Asadourian

, et al. The epidemiology of carpal tunnel revision over a 1-year follow-up period. J Hand Surg Am. 2021;46(9):758-764. doi:10.1016/j.jhsa.2021.04.003.

Lyman

Schreiber

, et al. The epidemiology of reoperation after flexor pulley reconstruction. J Hand Surg Am. 2013;38(9):1705-1711. doi:10.1016/j.jhsa.2013.05.015.

10.

Kurucan

Thirukumaran

Hammert

. Trends in the management of traumatic upper extremity amputations. J Hand Surg Am. 2020;45(11):1086.e1-1086.e11. doi:10.1016/j.jhsa.2020.05.006.

11.

Park

Boyer

Gelberman

, et al. Simultaneous bilateral versus staged bilateral carpal tunnel release: a cost-effectiveness analysis. J Am Acad Orthop Surg. 2016;24(11):796-804. doi:10.5435/JAAOS-D-15-00620.

12.

Centers for Medicare & Medicaid Services. Data dissemination. https://download.cms.gov/nppes/NPI_Files.html. Published 2021. Accessed October 26, 2023.

13.

American Society for Surgery of the Hand. Membership directory. https://www.assh.org/s/member-directory. Published 2021. Accessed November 30, 2021.

14.

Centers for Medicare & Medicaid Services. National downloadable file. https://data.cms.gov/provider-data/dataset/mj5m-pzi6. Published 2020. Accessed October 26, 2023.

15.

Agency for Healthcare Research and Quality. HCUP clinical classifications software refined (CCSR) for ICD-10-CM diagnoses, v2021.2. Healthcare cost and utilization project. https://hcup-us.ahrq.gov/search/results.jsp#stq=HCUP%20clinical%20classifications%20software%20refined%20(CCSR)%20for%20ICD-10-CM%20diagnoses%2C%20v2021.2.%20Healthcare%20cost%20and%20utilization%20projec&stp=1

16.

Zieske

Ebersole

Davidge

, et al. Revision carpal tunnel surgery: a 10-year review of intraoperative findings and outcomes. J Hand Surg Am. 2013;38(8):1530-1539. doi:10.1016/j.jhsa.2013.04.024.

17.

American Society for Surgery of the Hand. Subspecialty certificate in surgery of the hand. https://www.assh.org/s/subspecialty-certificate-hand-surgery. Published 2022. Accessed February 13, 2022.

18.

Camp

Ryan

Degen

, et al. Risk factors for revision surgery following isolated ulnar nerve release at the cubital tunnel: a study of 25,977 cases. J Shoulder Elbow Surg. 2017;26(4):710-715. doi:10.1016/j.jse.2016.10.028.

19.

CMS.gov. Billing and coding: use of laterality modifiers. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56869. Published 2022. Accessed June 12, 2022.

20.

Zhou

Ceyisakar

Hovius

SER

, et al. Surgeon volume and the outcomes of Dupuytren’s surgery: results from a Dutch multicenter study. Plast Reconstr Surg. 2018;142(1):125-134. doi:10.1097/PRS.0000000000004512.

21.

Agee

McCarroll

Tortosa

, et al. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am. 1992;17(6):987-995. doi:10.1016/S0363-5023(09)91044-9.

22.

Williamson

ERC

Vasquez Montes

Melamed

Multistate comparison of cost, trends, and complications in open versus endoscopic carpal tunnel release. Hand (N Y). 2021;16(1):25-31. doi:10.1177/1558944719837020.

23.

Sun Cao

Loewenstein

Timsina

, et al. The association of insurance status and complications after carpal tunnel release. Hand. 2023;18:192-197. doi:10.1177/1558944721990818.

24.

Blais

Rider

Sturgeon

, et al. Establishing objective volume-outcome measures for anterior and posterior cervical spine fusion. Clin Neurol Neurosurg. 2017;161:65-69. doi:10.1016/j.clineuro.2017.08.009.

25.

Lyman

Jones

Bach

, et al. The association between hospital volume and total shoulder arthroplasty outcomes. Clin Orthop Relat Res. 2005;432:132-137. doi:10.1097/01.blo.0000150571.51381.9a.

26.

Mathen

Nosrati

Merrell

. Decreased rate of complications in carpal tunnel release with hand fellowship training. J Hand Microsurg. 2018;10(1):26-28. doi:10.1055/s-0037-1618913.

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Incidence and Risk Factors for Revision Within 1 Year of Primary Carpal Tunnel Release