"Impact of regional surgeon competition on use and costs of carpal tunnel releases".

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

: Using 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.