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
