Predictors of Patient Migration for Staged Bilateral Carpal Tunnel Release Procedures.

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Clinical relevance: These results may inform the design of future prospective studies to better understand key factors contributing to patient migration.