DOI: 10.1097/prs.0000000000013296 ISSN: 0032-1052

“Impact of regional surgeon competition on use and costs of carpal tunnel releases”

T.K. Kevin Chan, Yanbing Zhong, Lu Wang, Kevin C. Chung
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Background:

Endoscopic CTR (ECTR) accounts for a growing proportion of surgeries over open CTR (OCTR). In a cost-conscious healthcare environment, it is important to characterize the drivers of high-cost care, since OCTR can be performed with similar outcomes but less costs. We investigated whether regional surgeon competition affects the type of CTR.

Methods

: U sing MarketScan claims data from 2018 to 2022, we calculated the Herfindahl–Hirschman Index, a measure of market competition. Multivariable regression was used to identify factors affecting the type of CTR performed, costs, and complications

Results:

There were 41,593 OCTR (71.9%) and 16,274 ECTR (28.1%) identified. Competitive markets were associated with 12% higher odds of performing ECTR, leading to an increase of $37.68 in patient out-of-pocket costs and $347.45 in total healthcare costs. Regional surgeon competition was not associated with differences in complications after CTR.

Conclusions:

Surgeons in competitive markets have greater odds of performing ECTR over OCTR, which are more costly. Surgeons should recognize the potential influence of non-medical factors in the management of carpal tunnel syndrome. The selective performance of ECTR through shared decision-making can be considered.

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