Abstract
PurposeCarpal tunnel syndrome (CTS) is a symptomatic compression neuropathy of the median nerve. This study investigated the value of candidate prognostic factors (PFs) in predicting carpal tunnel release surgery.Patients and methodsThis is a retrospective cohort study set in the Clinical Practice Research Datalink. Patients ≥18 years presenting with an incident episode of CTS were identified between 1989 and 2013. Candidate PF’s defined in coded electronic patient records were identified following literature review and consultation with clinicians. Time to first carpal tunnel release surgery was the primary end point. A manual backward stepwise selection procedure was used to obtain an optimal prediction model, which included all the significant PFs.ResultsIn total, 91,412 patients were included in the cohort. The following PFs were included in an optimal model (C-statistic: 0.588 [95% CI 0.584–0.592]) for predicting surgical intervention: geographical region; deprivation status; age hazard ratio (HR 1.02 per year, 95% CI 1.01–1.02); obesity (HR 1.23, 95% CI 1.19–1.27); alcohol drinker (HR 1.05, 95% CI 1.00–1.10); smoker (HR 1.06, 95% 1.03–1.10); inflammatory condition (HR 1.13, 95% CI 0.98–1.29); neck condition (HR 1.13, 95% CI 1.03–1.23); and multisite pain (HR 1.10, 95% CI 1.05–1.15). Although not included in the multivariable model, pregnancy (if gender female) within 1 year of the index consultation, reduced the risk of surgery (HR 0.24, 95% CI 0.21–0.28).ConclusionThis study shows that patients who are older and who have comorbidities including other pain conditions are more likely to have surgery, whereas patients presenting with CTS during or within a year of pregnancy are less likely to have surgery. This information can help to inform clinicians and patients about the likely outcome of treatment and to be aware of which patients may be less responsive to primary care interventions.
Highlights
Carpal tunnel syndrome (CTS) is a chronic focal compressive neuropathy caused by the entrapment of the median nerve at the level of the carpal tunnel in the wrist.[1]
This time to event analysis included the censoring of patients when they received Carpal tunnel release surgery (CTR), were recorded as deceased, left the practice, or the practice no longer contributed to Clinical Practice Research Datalink (CPRD)
253 patients with a diagnostic code attributed on the same day as a CTR code, and 8 patients diagnosed on their “end date” had no follow-up period to observe and were not included in the analyses
Summary
Carpal tunnel syndrome (CTS) is a chronic focal compressive neuropathy caused by the entrapment of the median nerve at the level of the carpal tunnel in the wrist.[1]. Symptoms are usually localized to the hand but can spread proximally to the forearm, upper arm, and even shoulder.[3] Despite usually causing relatively localized symptoms, CTS can have substantial physical, psychological, and economic consequences.[4,5] Previous studies have sought to estimate the prevalence and/ or incidence of CTS.
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