Trends in Open and Endoscopic Carpal Tunnel Release: Medicare Projections Through 2040

Abstract

Background:

Carpal tunnel release (CTR) is one of the most commonly performed hand surgeries, with both open and endoscopic techniques widely used. This study analyzes US historical trends in CTR utilization among Medicare beneficiaries and projects future procedural volumes through 2040.

Methods:

Medicare Part B National Summary data from 2000 to 2022 were used to estimate annual procedural volumes for open (Current Procedural Terminology [CPT] 64721) and endoscopic (CPT 29848) CTR. Adjustments were made to account for the increasing proportion of Medicare Advantage enrollees. Four forecasting models—log-linear, Poisson regression, negative binomial regression, and auto-regressive integrated moving average (ARIMA)—were applied. Model performance was evaluated using mean absolute error and root mean square error, with ARIMA selected for its superior predictive accuracy.

Results:

From 2000 to 2022, the annual volume of open CTR increased by 180%, while endoscopic CTR grew by 959%. Auto-regressive integrated moving average projections indicate that open CTR will continue to grow at an average annual rate of 2.0%, reaching an estimated 424 271 procedures by 2040. Endoscopic CTR is projected to increase at a faster rate of 2.42% annually, with a forecasted volume of 184 723 by 2040. Despite this growth, open CTR is expected to remain the predominant approach.

Conclusions:

Carpal tunnel release utilization has increased substantially in the United States, with endoscopic techniques growing at a faster rate than open CTR. Despite this trend, open CTR is projected to remain the predominant approach. Future research should assess the economic impact, patient-reported outcomes, and factors influencing the adoption of each technique.