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Predicting surgical intervention in patients presenting with carpal tunnel syndrome in primary care

Burton, Claire L; S Chesterton, Linda; Chen, Ying; Van Der Windt, Danielle

Predicting surgical intervention in patients presenting with carpal tunnel syndrome in primary care Thumbnail


Linda S Chesterton

Ying Chen


Purpose: Carpal 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 methods: This 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. Results: In 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). Conclusion: This 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.

Journal Article Type Article
Acceptance Date Mar 6, 2018
Publication Date Jun 29, 2018
Publicly Available Date May 26, 2023
Journal Clinical Epidemiology
Print ISSN 1179-1349
Publisher Dove Press
Pages 739 - 748
Keywords carpal tunnel syndrome, epidemiology, primary care, prognosis
Publisher URL