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Utilization of Carpal Tunnel Release in the United States by Settlement Type: Is There Equity of Access?
Nader Mujtaba
*1, Luke J. Llaurado
*1, Kishan S. Shah
1, Imran Khan
2, David Song
1, Stephen Baker
11Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, ; 2Orthopaedic Surgery, Inova, Fairfax, VA
Background: With over 400,000 procedures performed annually, Carpal Tunnel Release (CTR) is among the most common hand surgeries in the U.S. While common, the geographic distribution of CTR surgery and providers has not been investigated. Our study characterizes CTR utilization across communities ranging from metropolitan to rural, to examine disparities in access to care.
Methods: CMS Medicare Provider Utilization and Payment Data was analyzed from 2013-2023 to identify all plastic and orthopaedic surgeons who performed CTR each year. ZIP codes for each CTR case were mapped to Rural-Urban Commuting Area codes, and classified by settlement type: urban/metropolitan, micropolitan, small town, or rural. The number of CTR-performing surgeons, total CTR case volumes, and median annual CTR cases per surgeon were calculated for each type. Trends over time in surgeon counts and procedure volumes by settlement types were assessed using two-sided Mann-Kendall trend tests (significance level p<0.05).
Results: From 2013 to 2023, open and endoscopic CTRs were billed by 4,369 surgeons. The distribution of CTRs across settlement types was heavily skewed toward urban/metropolitan regions, accounting for 89.8% of all procedures, followed by micropolitan (8.7%), small town (1.1%), and rural (0.3%). Urban/metropolitan surgeons performed a median of 27.2 CTRs per surgeon per year, the highest volume across all settlement types. Over the study period, the number of CTR-performing surgeons declined across non-urban regions: 26% in micropolitan areas (p<0.01), 38% in small towns (p<0.01), and 50% in rural areas (p<0.01).
Conclusion: There are significant geographic disparities in the utilization of CTR. Despite 20% of Americans residing in rural areas, only about 0.3% of CTR surgeries were performed in those areas, highlighting dramatic inequity. Additionally, the number of CTR surgeons in non-urban areas appears to be declining over time. These findings represent an urgent need to address the maldistribution of hand surgery services and restore access for CTR patients in rural America.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
