The Impact of Clinical Practice Guidelines on Preoperative Antibiotic Administration for Carpal Tunnel Release

Hand ◽  
2022 ◽  
pp. 155894472110635
Author(s):  
Saurabh Mehta ◽  
Tannor Court ◽  
Alexander Graf ◽  
Cameron Best ◽  
Robert Havlik
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Antibiotic Administration ◽  
Patient Demographics ◽  
Preoperative Antibiotics ◽  
The Impact ◽  
To Receive

Background: In 2015, the American Association of Plastic Surgeons (AAPS) published a consensus statement against the routine use of preoperative antibiotic prophylaxis to prevent surgical site infection in clean hand surgery. The American Academy of Orthopaedic Surgeons (AAOS) similarly cited “insufficient evidence” in its Appropriate Use Criteria guidelines to support the use of antibiotics in carpal tunnel surgery. Nonetheless, its administration remains a common practice during clean hand surgery. We sought to evaluate the impact of the above guidelines on preoperative antibiotic administration. Methods: An institutional review board–approved retrospective chart review of consecutive patients with carpal tunnel syndrome treated with open carpal tunnel release (CTR) at our institution was performed in the 2 years before and after publication of AAPS/AAOS guidelines. Patient demographics and surgical outcomes were reviewed. Incidence of antibiotic administration, patient demographics, and surgeon factors were collected. Results: A total of 770 primary open CTR procedures were performed in the studied years. In 2013 and 2014, 83.9% of patients received preoperative antibiotics. In 2017 and 2018, 48.2% of patients received preoperative antibiotics. Of the variables analyzed, immunosuppression, history of diabetes, and poorly controlled diabetes (A1c > 7) were found to be statistically significant in its positive correlation to prophylactic preoperative antibiotic use. Diabetes was not associated with surgical site infections. Conclusion: Patients were more likely to receive preoperative antibiotics before the publication of the AAPS/AAOS clinical practice guidelines. Patients with diabetes regardless of their glycemic control are more likely to receive preoperative antibiotics.

The Association of Insurance Status and Complications After Carpal Tunnel Release

Hand ◽  
2021 ◽  
pp. 155894472199081
Author(s):  
Phoebus Sun Cao ◽  
Scott N. Loewenstein ◽  
Lava R. Timsina ◽  
Joshua M. Adkinson
Keyword(s):  
Carpal Tunnel ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Carpal Tunnel Release ◽  
Pain Syndrome ◽  
Hand Surgery ◽  
Insurance Status ◽  
Commercial Insurance ◽  
Patient Demographics ◽  
Wound Breakdown

Background: Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR. Methods: We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included. Results: Of the 26 151 patients who met inclusion criteria, 2662 (10.2%) had Medicare, 7027 (26.9%) had Medicaid, and 16 462 (62.9%) had commercial insurance. Compared with Medicare, Medicaid status ( P < .001) and commercial insurance status ( P < .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications. Conclusions: The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.

Measuring the impact of clinical practice guidelines on infantile hemangioma referrals

2021 ◽  
Author(s):  
Michael T. Barton ◽  
Emile Latour ◽  
Alison Small ◽  
Sabra Leitenberger ◽  
Tracy Funk
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Infantile Hemangioma ◽  
The Impact

Endoscopic Carpal Tunnel Release

2019 ◽  
pp. 989-994
Author(s):  
Antony Hazel ◽  
Neil F. Jones
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Anatomical Landmarks ◽  
Transverse Carpal Ligament ◽  
Palmar Arch ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery ◽  
Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

scholarly journals Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema

2002 ◽  
Vol 82 (10) ◽  
pp. 1009-1016 ◽  
Author(s):  
Julie E Donachy ◽  
Emily L Christian
Keyword(s):  
Physical Therapy ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Tourniquet Time ◽  
Compression Bandaging ◽  
Right Hand ◽  
Tunnel Syndrome ◽  
Chronic Lymphedema

Abstract Background and Purpose. This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. Case Description. The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. Outcomes. Following surgical release, the patient' s numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. Discussion. This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.

Revision Surgery after Carpal Tunnel Release –Analysis of the Pathology in 200 Cases during a 2 Year Period

2006 ◽  
Vol 31 (1) ◽  
pp. 68-71 ◽  
Author(s):  
N. STÜTZ ◽  
A. GOHRITZ ◽  
J. VAN SCHOONHOVEN ◽  
U. LANZ
Keyword(s):  
Carpal Tunnel ◽  
Revision Surgery ◽  
Carpal Tunnel Release ◽  
Operative Procedure ◽  
Hand Surgery ◽  
Scar Tissue ◽  
Technical Errors ◽  
Number Of Patients ◽  
Release Analysis ◽  
Specific Reason

Carpal tunnel release (CTR) is regarded as a common and successful operative procedure in hand surgery. However, an increasing number of patients with complications have been referred to our hospital. This retrospective investigation was undertaken to clarify the reasons for persisting or recurrent symptoms in 200 patients who underwent secondary exploration during a 26 month period at a single institution. In 108 cases, the flexor retinaculum was found to have been released incompletely. In 12 patients, a nerve laceration had occurred during the primary intervention. In 46 patients, symptoms were due to the nerve being tethered in scar tissue. The re-exploration revealed circumferential fibrosis around and within the median nerve in 17 patients and a tumour in the carpal tunnel in four patients. In 13 patients, no specific reason was found for recurrence of symptoms. We conclude that CTR seems to be a widely underestimated procedure and revision surgery could be largely avoided by reducing technical errors during the primary operation.

Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma

2009 ◽  
Vol 35 (3) ◽  
pp. 228-231 ◽  
Author(s):  
S. M. Koh ◽  
F. Moate ◽  
D. Grinsell
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Range Of Motion ◽  
Grip Strength ◽  
Complex Regional Pain Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Pain Syndrome ◽  
Hand Surgery ◽  
Pain Scores ◽  
Tunnel Syndrome

This study highlights the benefits of carpal tunnel release (CTR) in four patients presenting with complex regional pain syndrome (CRPS) after hand surgery who also had carpal tunnel syndrome (CTS) diagnosed clinically and by nerve conduction studies. Three of the patients underwent pre- and postoperative volumetric, circumference, grip strength and range of motion measurements. The Disabilities of the Arm, Shoulder and Hand (DASH) functional outcome measure and pain scores were also used. There was almost complete resolution of CRPS symptoms in all four patients, with notable reductions in oedema and improvements in grip strength and range of motion. There were also improvements in DASH outcome scores and pain scores after CTR.

The results of carpal tunnel release for carpal tunnel syndrome diagnosed on clinical grounds, with or without electrophysiological investigations: a randomized study

2012 ◽  
Vol 38 (1) ◽  
pp. 44-49 ◽  
Author(s):  
A. Żyluk ◽  
Z. Szlosser
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Carpal Tunnel Release ◽  
Randomized Study ◽  
Clinical Importance ◽  
Nerve Conduction Studies ◽  
Pinch Strength ◽  
Tunnel Syndrome ◽  
To Receive

We compared the results of carpal tunnel release in patients with the diagnosis of carpal tunnel syndrome based on only clinical grounds and those diagnosed on clinical and electrophysiological grounds. Ninety-three patients, 83 women (89%) and ten men (11%), meeting the criteria of ‘typical’ carpal tunnel syndrome, were randomly assigned to receive carpal tunnel release with ( n = 45, 48%) or without ( n = 48, 52%) nerve conduction studies. Patients were followed-up at 1 and 6 months, by assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 months assessments. Statistically significant differences were noted in three-point pinch strength and sensation; however, they were not of clinical importance. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after nerve conduction studies and, therefore, nerve conduction studies can be omitted.

scholarly journals Litigation Following Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 466-470 ◽  
Author(s):  
Nishant Ganesh Kumar ◽  
Nicholas Hricz ◽  
Brian C. Drolet
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
The United States ◽  
Fellowship Training ◽  
Malpractice Claims ◽  
Predominantly Female ◽  
Median Nerve Injury

Background: Carpal tunnel release (CTR) is the most common hand surgery operation performed in the United States. While serious complications are rare, they can be life-altering to patients. In some cases, patients will pursue malpractice claims against the surgeon. This study aimed to understand the patient, procedure, and surgeon factors involved in CTR malpractice litigation. Methods: The Westlaw legal database was queried for all recorded CTR malpractice cases resulting in jury verdicts and settlements. Only cases directly related to injury after CTR were included in this study. Cases were reviewed to determine plaintiff demographics, defendant training, liability, injury, outcomes, and monetary awards. Results: Ninety-two unique cases were identified. Plaintiffs were predominantly female (n = 65, 71%). Most surgeons were orthopedic-trained (n = 37, 52%). Only 27% of defendants (n = 19) were hand fellowship-trained. Only 19% of cases resulting in a monetary award were against surgeons who had hand fellowship training. The majority of cases (n = 61, 66%) were found in favor of the defendant. Monetary awards averaged $305 923 (range = $12 000-1 338 147), while settlements averaged $266 250. Alleged liability was most for surgeon negligence (n = 69, 75%) with a third of cases resulting in monetary awards. Median nerve injury was claimed in 41 cases (45%), with 17 (41%) resulting in monetary awards. Conclusion: Although CTR is generally safe and effective, some patients will experience complications. Median nerve injury was the most common reason for successful litigation in this study. Adequate training and experience in hand surgery may lower the risk of injuries resulting in successful malpractice suits.

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