Foster Brock D, Sivasundaram Lakshmanan, Heckmann Nathanael, Cohen Jeremiah R, Pannell William C, Wang Jeffrey C, Ghiassi Alidad
University of Southern California, Los Angeles, USA.
Hand (N Y). 2017 Mar;12(2):162-167. doi: 10.1177/1558944716643276. Epub 2016 Jul 8.
Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.
一旦保守治疗失败，通常会对腕管综合征患者进行腕管松解术（CTR）。手术技术和麻醉方式因外科医生的偏好和患者因素而异。然而，迄今为止，在美国尚未在全国范围内描述CTR的手术实践和麻醉趋势。利用PearlDiver患者记录数据库搜索2007年至2011年选择性CTR的现行手术操作术语代码。记录了该患者群体的麻醉方式（如全身麻醉和区域麻醉与局部麻醉）和手术方式（如内镜手术与开放手术）。对成本分析、患者人口统计学、区域差异和CTR手术的年度变化进行了评估。我们确定了在这5年期间接受腕管手术的86687名患者。在这个患者样本中，80.5%的CTR手术采用全身麻醉或区域麻醉，而采用局部麻醉的手术占19.5%；所有CTR手术中有83.9%采用开放方式进行，16.1%采用内镜技术进行。内镜手术平均比开放手术贵794美元，全身麻醉或区域麻醉比局部麻醉贵654美元。在美国，局部麻醉下的开放CTR是进行CTR最具成本效益的方法。然而，只有一小部分选择性CTR手术采用这种技术，这是一个可能大幅节省医疗成本的潜在领域。此外，在手术和麻醉类型的使用上存在地区和年龄差异。
