Open versus endoscopic carpal tunnel release: A decision analysis

The endoscopic technique for the surgical treatment of carpal tun nel syndr ome was developed to decrease postoperative morbidity and accelerate a pati ent's return to normal activities and work. We used the methods of decision analysis to compare the total cost of the open versus the endoscopic techn ique. We adopted a societal perspective and included estimates of the costs of medical procedures and complications, as well as lost wages. Our base c ase analysis showed that the 2 techniques have similar total costs, given t he assumptions of our model. The endoscopic approach is more costly if the complication rate of endoscopic-surgery exceeds; 6.2% (base case estimate, 5.0%). The endoscopic technique is more costly if the risk of career ending injury exceeds 0.001 (base case estimate, 0.0004) and if the average work absence following a complication exceeds 15.5 months (base case estimate, 1 2 months). In addition, the endoscopic technique is more costly if the diff erence between the 2 techniques in mean time to return to work is less than 21 days (base case estimate, 26 days). These findings have different impli cations for recipients and nonrecipients of workers' compensation. If endos copically treated patients return to work an average of 42 days faster than patients treated with the open technique (24 days vs 66 days), as was docu mented for nonrecipients of workers' compensation in one large study, the e ndoscopic strategy would be less costly ($5,599 for endoscopic release vs $ 7,340 for open surgery). If endoscopically treated patients return to work an average of just 10 days sooner (103 days vs 113 days), however, as was d ocumented for workers' compensation recipients in the same study, the open technique would be less costly ($11,353 for open release vs $11,959 for the endoscopic technique). The relative costs are not sensitive to the direct medical costs of complications. These findings allow prediction of the cost s of endoscopic and open surgery under a range of assumptions concerning ke y parameters. The analyses also emphasize the need for more precise data on risks and costs of surgical treatments for carpal tunnel syndrome, (J Hand Surg 1999;24A:1109-1117. Copyright (C) 1999 by the American Society for Su rgery of the Hand.).