Appropriateness of carpal tunnel syndrome management compared with the AAOS appropriate use criteria: A retrospective review across various specialties

PURPOSE: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder among adults that causes upper-extremity disability. The American Academy of Orthopedic Surgeons (AAOS) developed an evidence-based appropriate use criteria (AUC) for the management of CTS. This study aimed to assess the appropriateness of our practice and the usability of the AUC through comparing the actual management provided at our institution with that recommended by the AUC. METHODS: A retrospective review of the electronic medical records at our hospital was performed between 1 Jan 2016 and 31 Dec 2019. Data were collected by two authors independently. The collected data were input into the AUC application to determine the rate of the appropriateness of the treatments. Afterwards, the agreement between the actual treatment provided and the AUC recommendation was assessed. The primary outcome was the appropriateness rate. Descriptive statistics such as the mean, range and percentage were used to summarize the patients’ demographics and treatment options. RESULTS: There were 127 patients (169 interventions), with a mean age of 50.18 years (range, 24–85 years). Most of the included patients were females, 78% (99). Obesity was the most frequent risk factor 64.5% (82), and bilateral wrist involvement was the most common presentation 58% (74). The overall appropriateness rate and agreement with the AUC recommendations among all interventions was 84%. A sub-analysis of carpal tunnel surgical release across different surgical specialities showed appropriateness rates of 88%, 89%, 54% in orthopaedic surgery, neurosurgery and plastic surgery teams, respectively (Chi(2) 19.54, P-Value 0.000613). CONCLUSION: This study demonstrated that most of the treatments provided at our institution were appropriate and in agreement with the AUC recommendations. Additionally, the AUC for carpal tunnel syndrome is a valuable and practical tool that can be applied in clinical settings. LEVEL OF EVIDENCE: Retrospective study, level IV.