The impact of procedure type, jurisdiction and other factors in workers' compensation on work-disability outcomes following carpal tunnel surgery.

Carpal tunnel syndrome (CTS) is often work-related and associated with prolonged disability. While surgical treatment is common, an alternative endoscopic procedure has been promoted as a way of achieving better outcomes. However, little is known about typical use of the procedure and whether it actually achieves outcomes in community settings. From workers' compensation claims reported to an insurer in six jurisdictions during 1995-1999, we identified 1697 individuals with a single CTS surgery, 17% were treated using the endoscopic procedure. Bivariate analyses of post-surgical outcomes demonstrated that post-surgical work disability was shorter for those with endoscopic procedures (median 27 vs. 34 days, mean 62 vs. 85 days; p< 0.01). Medical costs following the procedure were also lower in the case of endoscopic procedure for those with any post-surgical medical costs (median $1,201 vs. $1,717, mean $5,733 vs. $7,084; p< 0.01). However, controlling for jurisdiction and other factors, these differences disappeared, suggesting that in CTS the type of care received was not a major determinant of outcomes. These findings reinforce the importance of community-based evaluations which include potential confounders to accurately evaluate the impact of medical technologies on work disability in occupational conditions.