REDUCING THE ECONOMIC IMPACT OF CARPAL TUNNEL SURGERY

Abstract

A large proportion of our patients are not salaried and many had expressed concerns about the amount of time taken off work following carpal tunnel surgery. Impressions were formed from information given by other health professionals or by friends and relatives who had previously undergone surgery. Some patients declined surgery because of their concerns over this particular issue. We therefore set out to challenge these traditional beliefs. This prompted us to adopt a more aggressive postoperative approach by encouraging immediate and unrestricted hand use following surgery. We found that patients were able to tolerate early activity and were able to return to work sooner than they had expected. For the purposes of this study, our aim was to identify when a return to any form of meaningful employment occurred, such that the individual was earning a salary. Consequently, we did not differentiate between the individual returning to either light or full duties. Subsequently, in a cohort of 494 patients prospectively studied, we have seen 93.1% patients return to work by two weeks and 99.4% by four weeks.

This has obvious benefits in terms of reducing loss of income. Individuals undergoing surgery now do not have to be concerned with taking lengthy periods of time off work with the financial implications for them and their families.

There are obvious economic implications to our findings. An individual back at work should not be claiming related sickness benefit. The Confederation of British Industry (May 2007) report a cost of £76.70 for each day an employee is off work due to sickness. An individual who is able to return to work even one week earlier than previously would have been expected following carpal tunnel surgery could theoretically produce a saving to the economy of £383. In this series there were 318 (64.4%) patients in employment indicating a potential economic saving of £121,794. Given that nationally there are about 50 000 carpal tunnel procedures carried out each year then the potential savings are significant.

There may be a number of reasons for our observations. The absence of a bulky restrictive dressing and sling following surgery clearly allows immediate mobilization to occur. Our service allows the development of a close professional relationship based on trust between the operator and the patient. This ultimately reassures patients who, we believe, feeling more involved in decisions about their post-operative care, are consequently well-motivated and have the confidence to use their hand immediately following surgery. We have seen a low postoperative complication rate in this group of patients, in particular, a low incidence of swelling, stiffness and scar sensitivity. Reasons for these low complication rates are unclear, but we would suggest that early mobilisation protects patients against these particular problems.