“Impact of regional surgeon competition on use and costs of carpal tunnel releases”

BACKGROUND: Endoscopic CTR (ECTR) accounts for a growing proportion of surgeries over open CTR (OCTR). In a cost-conscious healthcare environment, it is important to characterize the drivers of high-cost care, since OCTR can be performed with similar outcomes but less costs. We investigated whether regional surgeon competition affects the type of CTR. METHODS: : Using MarketScan claims data from 2018 to 2022, we calculated the Herfindahl-Hirschman Index, a measure of market competition. Multivariable regression was used to identify factors affecting the type of CTR performed, costs, and complications. RESULTS: There were 41,593 OCTR (71.9%) and 16,274 ECTR (28.1%) identified. Competitive markets were associated with 12% higher odds of performing ECTR, leading to an increase of $37.68 in patient out-of-pocket costs and $347.45 in total healthcare costs. Regional surgeon competition was not associated with differences in complications after CTR. CONCLUSIONS: Surgeons in competitive markets have greater odds of performing ECTR over OCTR, which are more costly. Surgeons should recognize the potential influence of non-medical factors in the management of carpal tunnel syndrome. The selective performance of ECTR through shared decision-making can be considered.