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Gender, racial/ethnic, and socioeconomic disparities are known to exist in the diagnosis, treatment, and outcomes for a range of orthopaedic conditions. [1-7]

At the recent 2022 Annual Meeting of the American Academy of Orthopaedic Surgeons, researchers from Hospital for Special Surgery (HSS) presented data on another possible area of gender disparity in orthopaedics: treatment of carpal tunnel syndrome.

A Gray Area

It’s typical for patients who present with mild symptoms of carpal tunnel syndrome to be offered non-surgical treatments, such as bracing or steroid injections, and for patients with severe symptoms to be offered carpal tunnel release.

The gray area is the management of patients with moderate symptoms of carpal tunnel syndrome.

“For patients with moderate symptoms, it’s not as obvious whether a non-surgical or surgical approach is best,” said Duretti Fufa, MD, a hand and upper extremity surgeon at HSS and senior author of the study.

“There is more decision-making involved, and therefore a higher potential for patient factors and potentially subconscious biases to influence recommendations for surgery.”

Study Methods

For this study, Dr. Fufa and colleagues reviewed hospital records for 949 patients who had been treated for carpal tunnel syndrome at HSS between February 2016 and October 2020. All patients had been diagnosed by HSS hand surgeons and received electrodiagnostic testing. The researchers grouped patients’ records according to disease severity:

• Mild to moderate symptoms (37%, n=348)
• Moderate symptoms (24%, n=231)
• Moderate to severe symptoms (39%, n=370)

Outcomes of interest were:

• Treatment recommendations (non-surgical vs. surgical)
• Completion of treatment
• Time between the surgery recommendation and the procedure

These outcomes were compared by gender, race/ethnicity, and age.

Study Findings

The researchers reported 2 interesting findings within the moderate disease severity group (females= 141, males= 90):

• Females were 23% less likely to be offered surgery than males.
• Hispanic and Black females were 4 times less likely to be offered surgery than their male counterparts.

These trends were strong but not statistically significant, likely due to the size of the study cohort.

In addition, no difference was observed between genders in patients who actually underwent surgery (318 of 444 patients; 71% males, 72% females).

“Overall, our findings suggest that increased utilization by males was largely explained by the fact that men were more likely to present with more severe carpal tunnel syndrome,” Dr. Fufa said. “I suspect that with larger numbers of patients to study, differences based on gender and race may prove to be significant.

“In the meantime, we hope our findings increase awareness of potential biases to ensure we are providing equitable care to all patients.”

Source

Lee K, Aristega Almeida BA, Walker P, Kerluku J, Yang B, Fufa D, Assessing Gender Disparities in Indication for Carpal Tunnel Surgery (Poster P0177). Presented at the American Academy of Orthopaedic Surgeons’ 2022 Annual Meeting, March 22-26, 2022, Chicago, Illinois.

References

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3. Best MJ, Aziz KT, McFarland EG, Martin SD, Rue JH, Srikumaran U. Worsening racial disparities in patients undergoing anatomic and reverse total shoulder arthroplasty in the United States.
4. J Shoulder Elbow Surg. 2021 Aug;30(8):1844-1850. doi: 10.1016/j.jse.2020.10.023. Epub 2020 Nov 19.
5. Amen TB, Varady NH, Rajaee S, Chen AF. Persistent racial disparities in utilization rates and perioperative metrics in total joint arthroplasty in the U.S.: a comprehensive analysis of trends from 2006 to 2015. J Bone Joint Surg Am. 2020 May 6;102(9):811-820. doi: 10.2106/JBJS.19.01194.
6. Lan RH, Kamath AF. Post-acute care disparities in total joint arthroplasty Arthroplast Today. 2017 Mar 6;3(3):187-191. doi: 10.1016/j.artd.2017.02.001. eCollection 2017 Sep.
7. Kamath AF, Horneff JG, Gaffney V, Israelite CL, Nelson CL. Ethnic and gender differences in the functional disparities after primary total knee arthroplasty. Clin Orthop Relat Res. 2010 Dec;468(12):3355-61. doi: 10.1007/s11999-010-1461-y. Epub 2010 Jul 15.