Comparative Results in Bilateral Carpal Tunnel Surgery in 1 and 2 Stages

Abstract

Introduction Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with 3-5% and 50-70% being bilateral. It is believed that intervening simultaneously in 1 stage is associated with greater discomfort than in 2 stages and is associated with high costs for both the patient and the health systems.

Hypothesis Bilateral carpal tunnel surgical treatment in 1 stage is well tolerated, with similar postoperative evolution time and lower cost.

Methods Retrospective cohort study. Review of bilateral CTS files operated in 1 and 2 stages in 1 center, by the same team, between 2019-2022, follow-up 2 and 41 months. Interthenar open surgical technique.

It evaluated: absenteeism, Quick Dash, satisfaction, and costs. It considered the average income in Chile published by the National Institute of Statistics (INE) 2020 for the valuation of lost workdays (LWD). For the valuation of the cost of intervention, a quote for both surgical modalities were requested from the medical center in June 2022. For cost analysis, the conversion of Chilean pesos to dollars was carried out.

An Excel spreadsheet was used to compare the means of the 2 groups for the different parameters recorded with a significance level P of 0.05.

Results Of 538 surgeries performed at the medical center in the period analyzed, 118 were found to meet inclusion and exclusion criteria:

Group A: bilateral intervention in 1 stage. 26 patients, corresponding to 52 interventions. Average age 49.

Group B: bilateral intervention in 2 stages. 33 patients, corresponding to 66 patients. Average age 49.

Quick DASH group A v/s B average 1.74 v/s 3.23 p value 0.47. LWD 32.88 v/s 84.84; P value 0.00014. Satisfaction 88% vs. 91%, p 0.69. Surgical expense incurred was 4979.37 US v/s 5274.63 US

Considering the LWD difference was US 1503.26

Conclusion Surgical result is comparable without major discomfort. There was a significant difference in lost workdays and costs, favoring intervention in 1 stage.

Level of evidence III

Keywords

carpal tunnel - surgical treatment - cost analysis

Publication History

Received: 03 April 2023

Accepted: 26 November 2024

Article published online:
26 December 2024

• Bibliografía

• 1 Weber RA, Boyer KM. Consecutive versus simultaneous bilateral carpal tunnel release. Ann Plast Surg 2005; 54 (01) 15-19
• 2 Osei DA, Calfee RP, Stepan JG, Boyer MI, Goldfarb CA, Gelberman RH. Simultaneous Bilateral or Unilateral Carpal Tunnel Release? A Prospective Cohort Study of Early Outcomes and Limitations. J Bone Joint Surg Am 2014; 96 (11) 889-896
• 3 Park KW, Boyer MI, Gelberman RH, Calfee RP, Stepan JG, Osei DA. Simultaneous Bilateral Versus Staged Bilateral Carpal Tunnel Release: A Cost-effectiveness Analysis. J Am Acad Orthop Surg 2016; 24 (11) 796-804
• 4 Wang AA, Hutchinson DT, Vanderhooft JE. Bilateral simultaneous open carpal tunnel release: a prospective study of postoperative activities of daily living and patient satisfaction. J Hand Surg Am 2003; 28 (05) 845-848
• 5 Elfar JC, Foad MB, Foad SL, Stern PJ. A cost analysis of staged and simultaneous bilateral carpal tunnel release. Hand (N Y) 2012; 7 (03) 327-332
• 6 Chamorro C, Alvares D, Berger S, Balocci F, Rodríguez X, Soza F. Propiedades Psicométricas de la versión chilena del cuestionario Quick Disabilities of the Arm, Shoulder and Hand en pacientes con patología de hombro. Arch Med Deporte 2020; 37 (05) 305-309
• 7 Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 2006; 18 (07) 44
• 8 Pace V, Marzano F, Placella G. Update on surgical procedures for carpal tunnel syndrome: What is the current evidence and practice? What are the future research directions?. World J Orthop 2023; 18; 14 (01) 6-12
• 9 Instituto Nacional de Estadisticas de Chile. https://www.ine.gob.cl/