Abstract
BackgroundMusculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery. The objective of our study was to assess the overall and age-adjusted utilization rates of rotator cuff repair, shoulder arthroscopy performed for indications other than rotator cuff repair, carpal tunnel release, and wrist arthroscopy performed for indications other than carpal tunnel release in the United States. We also compared demographics, indications, and operating room time for these procedures.MethodsWe used the 2006 National Survey of Ambulatory Surgery to estimate the number of procedures of interest performed in the United States in 2006. We combined these data with population size estimates from the 2006 U.S. Census Bureau to calculate rates per 10,000 persons.ResultsAn estimated 272,148 (95% confidence intervals (CI) = 218,994, 325,302) rotator cuff repairs, 257,541 (95% CI = 185,268, 329,814) shoulder arthroscopies excluding those for cuff repairs, 576,924 (95% CI = 459,239, 694,609) carpal tunnel releases, and 25,250 (95% CI = 17,304, 33,196) wrist arthroscopies excluding those for carpal tunnel release were performed. Overall, carpal tunnel release had the highest utilization rate (37.3 per 10,000 persons in persons of age 45–64 years; 38.7 per 10,000 persons in 65–74 year olds, and; 44.2 per 10,000 persons in the age-group 75 years and older). Among those undergoing rotator cuff repairs, those in the age-group 65–74 had the highest utilization (28.3 per 10,000 persons). The most common indications for non-cuff repair related shoulder arthroscopy were impingement syndrome, periarthritis, bursitis, and instability/SLAP tears. Non-carpal tunnel release related wrist arthroscopy was most commonly performed for ligament sprains and diagnostic arthroscopies for pain and articular cartilage disorders.ConclusionsOur data shows substantial age and demographic differences in the utilization of these commonly performed upper extremity ambulatory procedures. While over one million upper extremity procedures of interest were performed, evidence-based clinical indications for these procedures remain poorly defined.
Highlights
Musculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery
Our final sample included records of rotator cuff repair (n = 407), shoulder arthroscopy performed for indications other than cuff repair, elbow arthroscopy (n = 10), carpal tunnel release (n = 1,028), and wrist arthroscopy performed for indications other than carpal tunnel repair
Estimated upper extremity ambulatory procedures An estimated 272,148 patients underwent rotator cuff repair, 257,541 patients underwent shoulder arthroscopy, 3,686 patients underwent elbow arthroscopy, 576,924 patients underwent carpal tunnel release, and 25,250 patients underwent wrist arthroscopy in the United States in the year 2006 (Table 1)
Summary
Musculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery. Indications, and operating room time for these procedures. The National Survey of Ambulatory Surgery (NSAS) is a Center for Disease Control and Prevention (CDC) based population sample survey of ambulatory surgery procedures performed in the United States [8]. The 2006 NSAS databases permit contemporary estimates of upper extremity orthopedic surgery. We sought to compare utilization, demographics, indications, and operating room time for most commonly performed ambulatory procedures of the upper extremity. This data is helpful in comparing commonly performed upper extremity orthopedic procedures and may assist policy makers and hospitals in projecting future needs to accommodate upper extremity procedural volume
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