Liimakka Adriana P, Amen Troy B, Rudisill Samuel S, Fufa Duretti
Harvard Medical School, Boston, MA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
J Hand Surg Am. 2025 Jul;50(7):812-818. doi: 10.1016/j.jhsa.2025.03.017. Epub 2025 Jun 5.
Staged bilateral carpal tunnel release (CTR) is a common surgical treatment for patients with bilateral carpal tunnel syndrome refractory to nonsurgical measures. Factors influencing whether a patient undergoes surgery on both hands by the same or different surgeons are not well characterized. This study aimed to identify patient and clinical factors associated with patient migration during staged bilateral CTR within 90 days of the index procedure.
Adult patients who underwent CTR between 2015 and 2022 were identified using the PearlDiver Mariner Database. Differences in patient demographic and clinical characteristics, surgical technique, and postoperative course were assessed between patients who underwent contralateral CTR within 90 days with the same surgeon who performed the index procedure, and those with a different surgeon. Multivariable logistic regression identified factors associated with patient migration while adjusting for potential confounding factors.
A total of 213,676 patients underwent staged bilateral CTR within the study period, of which 182,008 (85.2%) had both procedures performed by the same surgeon and 31,668 (14.8%) had them performed by two different surgeons. Factors independently associated with greater odds of patient migration included utilization of endoscopic technique for the index procedure (OR 1.20, 95% CI 1.17-1.23), incidence of postoperative complications following the index procedure (1.22, 1.09-1.36), and being insured by Medicaid (1.29, 1.23-1.34) relative to commercial insurance. Those residing in rural regions were less likely to change surgeons than those living in urban areas (0.85, 0.82-0.89).
Nearly 15% of patients had their contralateral CTR procedure performed by a different surgeon within three months of their index CTR. Patient migration was associated with Medicaid insurance, use of endoscopic techniques, postoperative complication, and urban residence.
These results may inform the design of future prospective studies to better understand key factors contributing to patient migration.
分期双侧腕管松解术（CTR）是一种常见的外科治疗方法，用于治疗非手术治疗无效的双侧腕管综合征患者。影响患者双手由同一位或不同外科医生进行手术的因素尚未得到充分描述。本研究旨在确定与初次手术90天内分期双侧CTR期间患者更换医生相关的患者和临床因素。
使用PearlDiver Mariner数据库识别2015年至2022年间接受CTR的成年患者。对在初次手术90天内由进行初次手术的同一位外科医生进行对侧CTR的患者与由不同外科医生进行手术的患者的人口统计学和临床特征、手术技术及术后病程差异进行评估。多变量逻辑回归在调整潜在混杂因素的同时确定与患者更换医生相关的因素。
在研究期间，共有213,676例患者接受了分期双侧CTR，其中182,008例（85.2%）的双侧手术由同一位外科医生进行，31,668例（14.8%）由两位不同的外科医生进行。与患者更换医生几率增加独立相关的因素包括初次手术采用内镜技术（比值比1.20，95%可信区间1.17-1.23）、初次手术后术后并发症发生率（1.22，1.09-1.36）以及相对于商业保险由医疗补助保险承保（1.29，1.23-1.34）。与居住在城市地区的患者相比，居住在农村地区的患者更换外科医生的可能性较小（0.85，0.82-0.89）。
近15%的患者在初次CTR术后三个月内由不同的外科医生进行对侧CTR手术。患者更换医生与医疗补助保险、内镜技术的使用、术后并发症及城市居住有关。
这些结果可为未来前瞻性研究的设计提供参考，以更好地了解导致患者更换医生的关键因素。
