gms | German Medical Science

Objectives/Interrogation: The demand for elective hand surgery in England is predicted to double by 2030 as compared to 2011. With such increase in demand, the U.K. must seek strategies to reduce costs of treatment whilst still maintaining standards of care. Carpal tunnel decompression (CTD) performed in a treatment room rather than in theatre may provide an alternative setting whilst achieving cost savings. As yet, there are no U.K. based studies that identify the risk of infection following surgery performed in a treatment room and there are no studies whatsoever assessing the qualitative outcomes from patients undergoing hand surgery outside a theatre environment.

Our aim in this study was to identify the incidence of infection following CTD when performed in a primary care setting and to assess the qualitative outcomes following the procedure via patient reported outcome measures (PROMs).

Methods: A prospective review was performed in all patients undergoing open CTD in one single primary care centre by a single surgeon between January 2012 and August 2017. All identified patients within the study period were asked to complete the Boston Carpal Tunnel Syndrome questionnaire (BCTQ). This was completed before surgery and again at 6 months following surgery via postal questionnaire. A superficial infection was defined as an infection treated by antibiotics, either enteral or intravenous. A deep infection was defined as a collection requiring surgical debridement in theatre. Independent and paired t-test statistical analysis using SPSS V.23 (IBM Corp.) was performed to test significance of qualitative outcomes.

Results and Conclusions: Completed outcomes were available for 335 patients. The average age at time of surgery was 59 (range 26 - 94). Seventy per cent of cases were female. Sixty-two per cent of patients had surgery on their dominant hand. Two superficial infections requiring treatment with antibiotics were identified resulting in a superficial infection rate of 0.6%. There were no deep infections identified. There was a statistically significant improvement in both symptom and functional outcomes following surgery with results comparable to other studies where surgery was performed in theatre.

We believe that carpal tunnel decompressions performed in a treatment room is both safe and effective and surgeons should consider this as an alternative setting to the main operating room.