Earp Brandon, Blazar Philip, Zhang Dafang
Orthopaedic Surgery, Brigham and Women's Hospital, Boston, USA.
Orthopaedic Surgery, Harvard Medical School, Boston, USA.
Cureus. 2024 Jul 29;16(7):e65687. doi: 10.7759/cureus.65687. eCollection 2024 Jul.
Rural populations are at risk for poorer access to health services and lower quality care, and recent policy efforts have focused on the reduction of rural-urban health inequities. The objective of this study was to identify differences in (1) patient demographic factors, (2) the utilization of confirmatory electrodiagnostic (EDS) testing, and (3) preoperative EDS severity between rural and urban populations undergoing carpal tunnel release (CTR).
We retrospectively identified 1,297 patients who underwent CTR at a tertiary referral center from July 2008 to June 2013. Exclusion criteria were acute trauma or infection, revision surgery, incomplete medical records, neoplasm excision, and the lack of rural-urban commuting area (RUCA) code for rural-urban classification. A final cohort of 1,138 patients who underwent CTR were included. The RUCA was used to classify patients by rural or urban residence. We assessed patient demographic factors including comorbidities, the utilization of confirmatory EDS testing, and preoperative EDS severity. A bivariate screen was performed for associations between rural-urban residence and our outcome variables, and variables with p <0.05 in the bivariate screen were included in a multivariable logistic regression model.
Of the 1,138 patients, 55 patients (5%) resided in a rural area and 1,083 patients (95%) resided in an urban area. No difference was found in the utilization of confirmatory EDS testing between rural and urban patients undergoing CTR. The final multivariable logistic regression model showed that rural residence was independently associated with older age, lower body mass index (BMI), and EDS-negative disease.
Rural patients undergoing CTR are more likely to have EDS-negative disease, which calls into question the effectiveness of EDS testing as a confirmatory test in this population. There is a paucity of literature on the outcomes of CTR in a rural population, and further studies are needed to ensure rural-urban equity in care.
农村人口获得医疗服务的机会较少且医疗质量较低，近期的政策努力集中在减少城乡医疗不平等。本研究的目的是确定接受腕管松解术（CTR）的农村和城市人群在以下方面的差异：（1）患者人口统计学因素；（2）确诊性电诊断（EDS）检查的使用情况；（3）术前EDS严重程度。
我们回顾性确定了2008年7月至2013年6月在一家三级转诊中心接受CTR的1297例患者。排除标准为急性创伤或感染、翻修手术、病历不完整、肿瘤切除以及缺乏用于城乡分类的城乡通勤区（RUCA）代码。最终纳入了1138例接受CTR的患者队列。使用RUCA按农村或城市居住地对患者进行分类。我们评估了患者人口统计学因素，包括合并症、确诊性EDS检查的使用情况以及术前EDS严重程度。对城乡居住地与我们的结局变量之间的关联进行了双变量筛选，双变量筛选中p<0.05的变量纳入多变量逻辑回归模型。
在1138例患者中，55例（5%）居住在农村地区，1083例（95%）居住在城市地区。接受CTR的农村和城市患者在确诊性EDS检查的使用方面未发现差异。最终的多变量逻辑回归模型显示，农村居住地与年龄较大、体重指数（BMI）较低以及EDS阴性疾病独立相关。
接受CTR的农村患者更有可能患有EDS阴性疾病，这使人质疑EDS检查作为该人群确诊性检查的有效性。关于农村人群CTR结局的文献较少，需要进一步研究以确保城乡医疗公平。
