Pomerance Jay, Zurakowski David, Fine Ilene
Harvard Medical School, Children's Hospital Boston, Department of Orthopedic Surgery, Boston, Massachusetts, USA.
J Hand Surg Am. 2009 Sep;34(7):1193-200. doi: 10.1016/j.jhsa.2009.04.034.
To compare direct costs and results for patients with electrodiagnostically proven carpal tunnel syndrome treated with surgery versus nonsurgical care.
There is a retrospective study of 120 patients divided into 2 groups: subjects in group 1 had chosen nonsurgical treatment, whereas subjects in group 2 had chosen surgery with no nonsurgical treatment. Patients were matched on age, gender, severity of nerve conduction abnormalities, body mass index, smoking history, job category, and insurance coverage. Direct cost of care was measured. An incremental cost-utility ratio was calculated to compare costs between the different management strategies.
Group 1 follow-up averaged 13 +/- 5 months compared to 12 +/- 2 months for group 2. Steroid injections were used in 18 patients in group 1. Thirty-two patients in group 1 elected to have surgery during the follow-up period. Cost of care averaged $3335 +/- $2097 in group 1 and $3068 +/- $983 in group 2.
The direct cost of nonsurgical care of confirmed carpal tunnel syndrome did not show a significant difference from that of surgical treatment without preoperative splinting or therapy. The incremental cost-utility ratio for carpal tunnel surgery was favorable. Surgery, rather than nonsurgical care, should be considered as the initial form of treatment when patients are diagnosed with carpal tunnel syndrome that is confirmed by nerve conduction studies, as this provides symptom resolution with a favorable cost analysis.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and Decision Analysis III.
比较经电诊断证实患有腕管综合征的患者接受手术治疗与非手术治疗的直接成本和结果。
对120例患者进行回顾性研究，分为两组：第1组患者选择非手术治疗，而第2组患者选择手术治疗且未接受非手术治疗。根据年龄、性别、神经传导异常的严重程度、体重指数、吸烟史、工作类别和保险范围对患者进行匹配。测量护理的直接成本。计算增量成本效用比以比较不同管理策略之间的成本。
第1组的随访平均为13±5个月，而第2组为12±2个月。第1组中有18例患者使用了类固醇注射。第1组中有32例患者在随访期间选择进行手术。第1组的护理成本平均为3335±2097美元，第2组为3068±983美元。
经证实的腕管综合征的非手术护理直接成本与未进行术前夹板固定或治疗的手术治疗相比，没有显著差异。腕管手术的增量成本效用比是有利的。当患者被诊断为经神经传导研究证实的腕管综合征时，应将手术而非非手术护理视为初始治疗形式，因为这能在成本分析良好的情况下缓解症状。
研究类型/证据水平：经济与决策分析III级。
