Risk of surgical site infection after carpal tunnel release performed in an operating room versus a clinic-based procedure room within a Veterans Affairs medical center

Abstract

Carpal tunnel release (CTR) is increasingly performed in a clinic-based procedure room (PR) environment, which is less restrictive than traditional operating rooms (ORs). It is unknown if there is an impact on surgical site infection (SSI) rates. Records of patients who underwent clean, elective CTR from October 2014 to April 2017 at a single site were identified using Current Procedural Terminology codes and charts reviewed using National Healthcare Safety Network SSI criteria. Procedure type and patient characteristics were assessed with multivariate logistic regression and costs compared using administrative data. A total of 312 procedures were included: 221 in OR and 91 in PR. SSI rate, including revisions, was 2.88% (nonrevision rate was 2.30%). Unadjusted SSI rate was 3.2% in OR and 2.2% in PR (P = .64). After adjusting for underlying risk factors, procedure setting was not associated with risk of SSI (P = .53; odds ratio, 0.43; 95% confidence interval, 0.03-5.94). Revision CTR was a predictor of SSI (P = .02; odds ratio, 28.21; 95% confidence interval, 1.84-434.57). The mean total cost of CTR in the OR was $4,254.21 and PR was $416.93. There was no significant difference in SSI rates for CTR performed in OR and PR environments. CTRs performed in a PR led to a 10-fold cost savings. Based on our findings of PRs as both safe and cost-effective, we recommend that more facilities explore the use of PRs for CTR.