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Surgical Approach and Anesthetic Modality for Carpal Tunnel Release

机译：腕管松解的手术方法和麻醉方式

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Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.
机译：背景：一旦保守治疗失败，通常会针对腕管综合症进行腕管松解术（CTR）。手术技术和麻醉方式因外科医生的喜好和患者因素而异。但是，迄今为止，在美国尚未在全国范围内描述CTR的做法和麻醉剂的趋势。方法：使用PearlDiver患者病历数据库搜索2007年至2011年选择性CTR的当前程序术语代码。为此记录了麻醉方式（例如全身麻醉和区域麻醉vs局部麻醉）和手术方式（例如内窥镜vs开腹）。患者人群。成本分析，患者人口统计学，地区差异和CTR手术的年度变化进行了评估。结果：我们鉴定了在这5年时间内接受腕管手术的86687名患者。在该患者样本中，使用全身或区域麻醉进行了80.5％的CTR手术，相比之下使用局部麻醉进行的CRT手术为19.5％;所有CTR的83.9％以开放方式进行，而16.1％使用内窥镜技术进行。内窥镜手术平均比开放手术贵794美元，而全身或区域麻醉比局部麻醉贵654美元。结论：在美国，在局部麻醉下进行开放性CTR是进行CTR的最经济有效的方法。但是，使用这种技术只能执行一小部分的选择性CTR程序，这代表了可节省大量医疗费用的潜在领域。此外，在使用的程序和麻醉剂类型方面存在地区和年龄差异。

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