Abstract
Meldgaard, Anette. Carpal tunnel syndrome. Prognostic and economical factors associated with endoscopic operation
Purpose: To identify prognostic factors for return to work and normalization of functional level after endoscopic operation for carpal tunnel syndrome. To consider the economical consequences in relation to the traditional open operation in a cost-effectiveness analysis with sick days gained as outcome measure.
Material and method: A prospective observational study of a fixed cohort. In all 99 persons were scheduled for endoscopic operation for the carpal tunnel syndrome. At base-line, a self-administered questionnaire was collected relating to physical, psychological and social circumstances in relation to the hand problem. The questionnaire was based on existing symptom- and functional scores for persons with the carpal tunnel syndrome. Data from a nerve conduction examination were collected at baseline and at the three months follow-up, when also a self-administered questionnaire was collected relating to duration of illness, work status, satisfaction with the operation, and symptom- and functional scores. On the basis of a simple occupational-corrected odds ratio, significant prognostic factors were identified through multiple logistic regression. In addition, a cost-effectiveness analysis was performed of endoscopic operations as compared to the conventional open type of operation. The effect was calculated as the weighted mean of the difference in number of post-operative sick days estimated in randomized clinical studies of endoscopic operation versus open operation.
Results: The mean funcional score was reduced from 2.3 to 1.4 after operation (SD 0.8) and the mean symptom score went from 2.9 to 1.5 (SD 0.7). In all, 24% had more than 21 sick days and 3% were still off sick at the end of the study. The most important prognostic findings for more than 21 post-operative sick days were: Pre-operative work-absence (OR 7.4, 95 CI 2.1-2.6), distal motor latency (OR 1.7, 95 CI 1.1-2.4), thoughts of change of work (OR 3.8, 95 CI 1.1-12), and blaming oneself for hand problem (OR 1.2 95% CI 1.01-1.5). However, when all variables were analyzed together, thoughts of change of work was no longer statistically significant. If 1,311DKK are added in the form of endoscopic operations for persons with uncomplicated cases of carpal tunnel syndrome, postoperatively this will result in a gain of 11 days of work absence. This will give a societal reduction in costs of 5,650DKK per person regardless work status and 7,012DKK for those actively employed.
Conslusion: Pre-operative work-absence, blaming oneself for hand problem and distal nerve conduction motor latency were prognostic factors for post-operative work absence. Endoscopic operation for the carpal tunnel syndrome in cost-effective when compared with the traditional open-type operation.
Purpose: To identify prognostic factors for return to work and normalization of functional level after endoscopic operation for carpal tunnel syndrome. To consider the economical consequences in relation to the traditional open operation in a cost-effectiveness analysis with sick days gained as outcome measure.
Material and method: A prospective observational study of a fixed cohort. In all 99 persons were scheduled for endoscopic operation for the carpal tunnel syndrome. At base-line, a self-administered questionnaire was collected relating to physical, psychological and social circumstances in relation to the hand problem. The questionnaire was based on existing symptom- and functional scores for persons with the carpal tunnel syndrome. Data from a nerve conduction examination were collected at baseline and at the three months follow-up, when also a self-administered questionnaire was collected relating to duration of illness, work status, satisfaction with the operation, and symptom- and functional scores. On the basis of a simple occupational-corrected odds ratio, significant prognostic factors were identified through multiple logistic regression. In addition, a cost-effectiveness analysis was performed of endoscopic operations as compared to the conventional open type of operation. The effect was calculated as the weighted mean of the difference in number of post-operative sick days estimated in randomized clinical studies of endoscopic operation versus open operation.
Results: The mean funcional score was reduced from 2.3 to 1.4 after operation (SD 0.8) and the mean symptom score went from 2.9 to 1.5 (SD 0.7). In all, 24% had more than 21 sick days and 3% were still off sick at the end of the study. The most important prognostic findings for more than 21 post-operative sick days were: Pre-operative work-absence (OR 7.4, 95 CI 2.1-2.6), distal motor latency (OR 1.7, 95 CI 1.1-2.4), thoughts of change of work (OR 3.8, 95 CI 1.1-12), and blaming oneself for hand problem (OR 1.2 95% CI 1.01-1.5). However, when all variables were analyzed together, thoughts of change of work was no longer statistically significant. If 1,311DKK are added in the form of endoscopic operations for persons with uncomplicated cases of carpal tunnel syndrome, postoperatively this will result in a gain of 11 days of work absence. This will give a societal reduction in costs of 5,650DKK per person regardless work status and 7,012DKK for those actively employed.
Conslusion: Pre-operative work-absence, blaming oneself for hand problem and distal nerve conduction motor latency were prognostic factors for post-operative work absence. Endoscopic operation for the carpal tunnel syndrome in cost-effective when compared with the traditional open-type operation.
| Original language | Danish |
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| Place of Publication | Århus |
| Publisher | |
| Publication status | Published - 2004 |