From the Department of Surgery, Division of Plastic Surgery, Michigan Medicine.
Departments of Surgery.
Plast Reconstr Surg. 2024 Mar 1;153(3):649-655. doi: 10.1097/PRS.0000000000010640. Epub 2023 May 15.
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and has severe long-term effects on hand function if surgery is delayed significantly following diagnosis. The authors investigated the timespan between diagnosis and surgical intervention for carpal tunnel syndrome among African American and White patients on Medicaid.
Using the MarketScan Truven Database Medicaid Supplement 2009 to 2020, the authors identified patients with CTS. Demographic data and time intervals between diagnosis and treatment were collected and analyzed using chi-square test and regression models.
A total of 361,942 African American and White Medicaid patients with a diagnosis of CTS were included in the study. Overall, 21.4% of White patients compared with 13.6% of African American patients chose surgery as their first and only option ( P < 0.001). A greater proportion of White patients underwent surgery less than 6 months after diagnosis compared with African Americans (75.5% and 67.7%, respectively; P < 0.001). African American women underwent surgery at a significantly lower rate compared with White women (13.8% and 21.8%, respectively); P < 0.001). Despite the increase in rates of surgery among both groups, the gap in use of surgery widened from a 6.6% difference in 2009 to a difference of 9.5% in 2020 between racial groups.
African American race and female sex are significantly correlated with choice of treatment and time to surgery among Medicaid patients with CTS. Identification of the relationship between health care disparities and the decision to undergo surgery is the first step in the development of strategies to mitigate underuse of this quality-of-life-improving procedure.
腕管综合征（CTS）是最常见的压迫性神经病变，如果在诊断后明显延迟手术，对手部功能会有严重的长期影响。作者研究了在医疗补助计划中，非裔美国人和白人患者从诊断到接受腕管综合征手术的时间间隔。
作者使用 MarketScan Truven 数据库 Medicaid 补充 2009 年至 2020 年的数据，确定了患有 CTS 的患者。收集并分析人口统计学数据和诊断与治疗之间的时间间隔，采用卡方检验和回归模型。
共有 361942 名患有 CTS 的非裔美国人和白人 Medicaid 患者纳入本研究。总体而言，与非裔美国人（13.6%）相比，白人患者中选择手术作为其首选和唯一治疗方案的比例更高（21.4%，P < 0.001）。与非裔美国人相比，更多的白人患者在诊断后 6 个月内接受手术（分别为 75.5%和 67.7%，P < 0.001）。与白人女性相比，非裔美国女性接受手术的比例明显较低（分别为 13.8%和 21.8%，P < 0.001）。尽管两组手术率都有所增加，但种族群体之间手术使用率的差距从 2009 年的 6.6%扩大到 2020 年的 9.5%。
非裔美国人种族和女性性别与 Medicaid 患者 CTS 治疗选择和手术时间有显著相关性。确定医疗保健差异与手术决策之间的关系是制定减轻这种改善生活质量手术使用率不足的策略的第一步。
