Factors Affecting Operative Duration in Isolated Open Carpal Tunnel Release

Abstract

Background Open carpal tunnel release (CTR) is one of the most commonly performed operative procedures with operative duration being a primary metric of operating room efficiency. The purpose of this study was to identify factors associated with prolonged operative duration, in performing CTR.

Materials and Methods CTR cases performed by a single surgeon from September 2013 to October 2015 were reviewed. Patient age at the time of surgery, sex, location of surgery (specialty orthopaedic hospital versus ambulatory surgery center), body mass index (BMI), American Society of Anesthesiologists classification, total operative duration (TOD), and procedure time (PT) were recorded. Obesity was defined as BMI > 30 and morbid obesity was defined as BMI > 35. Data were analyzed to identify factors associated with prolonged TOD or PT.

Results One hundred and nine consecutive patients underwent isolated CTR. Mean age at time of surgery was 62 years (range: 24–92 years). Nonobese patients were found to have significantly shorter TOD than obese patients (22.3 vs. 24.4 minutes). Similarly, patients who were not morbidly obese had significantly shorter TOD than morbidly obese patients (22.6 vs. 26 minutes). No other factors were associated with prolonged TOD. No difference in PT was found between normal weight, obese, and morbidly obese groups.

Conclusions TOD, but not procedure time, is significantly affected by obesity. Our findings are relevant when scheduling and preparing obese patients for surgery, which may have a significant impact on health resource utilization.

Level of Evidence This is a Level III, economic/decision analysis study.

Keywords

carpal tunnel release - efficiency - obesity - operating duration - risk factors

Note

This study was performed at the NYU Langone Orthopedic Hospital.

• References

• 1 Fajardo M, Kim SH, Szabo RM. Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting. J Hand Surg Am 2012; 37 (08) 1599-1605
• 2 Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord 2014; 15: 4
• 3 Dale AM, Harris-Adamson C, Rempel D. , et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013; 39 (05) 495-505
• 4 Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnel surgery. Instr Course Lect 1995; 44: 167-172
• 5 Berlet GC, Weil Sr LS, Fooman A, Miller JM. Contemporary trends in operating room efficiency. Foot Ankle Spec 2013; 6 (02) 125-131
• 6 Healey T, El-Othmani MM, Healey J, Peterson TC, Saleh KJ. Improving operating room efficiency, part 1: general managerial and preoperative strategies. JBJS Rev 2015; 3 (10) 01874474-201510000-00002
• 7 Healey T, Peterson TC, Healey J, El-Othmani MM, Saleh KJ. Improving operating room efficiency, part 2: intraoperative and postoperative strategies. JBJS Rev 2015; 3 (10) 01874474-201510000-00003
• 8 Gottschalk MB, Hinds RM, Muppavarapu RC. , et al. Factors affecting hand surgeon operating room turnover time. Hand (NY) 2016; 11 (04) 489-494
• 9 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii , 1–253
• 10 Allison DB, Zannolli R, Narayan KM. The direct health care costs of obesity in the United States. Am J Public Health 1999; 89 (08) 1194-1199
• 11 Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010; 303 (03) 235-241
• 12 Finkelstein EA, Khavjou OA, Thompson H. , et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med 2012; 42 (06) 563-570
• 13 Gadinsky NE, Manuel JB, Lyman S, Westrich GH. Increased operating room time in patients with obesity during primary total knee arthroplasty: conflicts for scheduling. J Arthroplasty 2012; 27 (06) 1171-1176
• 14 Wang JL, Gadinsky NE, Yeager AM, Lyman SL, Westrich GH. The increased utilization of operating room time in patients with increased BMI during primary total hip arthroplasty. J Arthroplasty 2013; 28 (04) 680-683
• 15 Kim BD, Hsu WK, De Oliveira Jr GS, Saha S, Kim JY. Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: an analysis of 4588 surgical cases. Spine 2014; 39 (06) 510-520
• 16 Sultan J, Charalambous CP. Theatre time utilisation in elective orthopaedic surgery. J Perioper Pract 2012; 22 (08) 262-265
• 17 Macario A. What does one minute of operating room time cost?. J Clin Anesth 2010; 22 (04) 233-236
• 18 Werner BC, Teran VA, Deal DN. Patient-related risk factors for infection following open carpal tunnel release: an analysis of over 450,000 medicare patients. J Hand Surg Am 2018; 43 (03) 214-219
• 19 Veltre DR, Yakavonis M, Curry EJ. , et al. Regional variations of medicare physician payments for hand surgery procedures in the United States. Hand (NY) 2017;