Open Versus Endoscopic Carpal Tunnel Release: A Decision Tool Guided by Multi-Criteria Decision Analysis Incorporating Patient-Reported Outcomes, Complications, and Cost.

Purpose: The purpose of this work was to develop a multi-criteria decision analysis model guided in part by early postoperative patient-reported data to compare open (OCTR) and endoscopic carpal tunnel release (ECTR) and create an interactive platform in the shared decision-making process. Our null hypothesis was that there would be no difference in patient-reported outcomes following OCTR or ECTR, and with all variables weighted equally, OCTR would be the preferred procedure, owing primarily to its lesser cost.

Methods: Data from patients who underwent OCTR or ECTR at an institution from 2018 to 2023 were collected. Patient-reported outcome data used in this study to reflect early postoperative experiences/value were collected in real time at the 2-week postoperative time point. Institutional financial data were collected. Complication data were pulled from the existing literature. Multi-criteria decision analysis modeling was then used to create an interface whereby patients and providers can manually adjust weights for each variable based on individual priorities.

Results: Nine hundred and eight patient encounters were included for data set modeling. When preferentially weighting transient nerve injury, recurrence, or patient cost as variables of importance, OCTR is the preferred procedure. When weighing permanent nerve injury, infection, or early improvement in pain/function, ECTR is the preferred procedure. The Curtis National Hand Center Carpal Tunnel Decision Matrix was subsequently created to provide real time results as the weight of each variable is adjusted.

Conclusions: This study presents a model guided by patient-reported outcome data as a reflection of the patient experience surrounding carpal tunnel release surgery. This decision aid tool is intended to be used for individual patient-level knowledge and decision-making as a reflection of patient attitudes.

Level of evidence/type of study: Decision analysis IV.