THE CARPAL TUNNEL SYNDROME: MEDICAL AND ECONOMIC ADVANTAGES OF WELL-TIMED SURGICAL TREATMENT

Autori:

Ranko Bilić, Robert Kolundžić, Vladimir Trkulja, Tomislav Crnković, Ana Vuković

Sažetak
Sindrom karpalnog kanala ponešto je zapostavljen medicinski, ali i ekonomski problem, a kirurški zahvat jedna je od terapijskih mogućnosti. U ovoj retrospektivnoj studiji analizirani su ishodi kirurškog liječenja u 114 konsekutivnih bolesnika (154 šake). Prije operacije, bolesnici su liječeni fizikalnom terapijom (96% slučajeva) i često su bili na bolovanju (42% slučajeva). Uoči operacije bol u šaci bila je jaka (medijan 7 na ljestvici 0-10), a funkcija bitno smanjena (medijan 2 na ljestvici 0-10). Nakon operacije (6-12 mjeseci), bol je bila slabija (razlika - 5,0,-95% GP -5,5 -4,5 p‹0,001), a funkcija bolja (razlika 4,5, 95% GP 4,0, 5,0, p‹0,001). Dulje vrijeme proteklo od javljanja obiteljskom liječniku do dolaska ortopedu (48% slučajeva › 1g)  bilo je nezavisni negativni prediktor za uspjeh operacije. Ukupna razlika troškova bolovanja i fizikalnih terapija prije i nakon operacije procijenjena je u naših bolesnika na približno 269.030,00 do nešto više od 375.315,00 eur. Za postizanje boljih medicinskih i ekonomskih rezultata, u bolesnika sa sindromom karpalnog kanala kojima je nužno kirurško liječenje, potrebno je skratiti razdoblje od njihova ulaska u sustav zdravstvene zaštite do samog liječenja..
Summary

Summary. Carpal tunnel syndrome (CTS) is a somewhat neglected medical and economic problem, and surgery is one of the therapeutic options. We analyze the outcomes of surgical treatment in 114 consecutive patients (154 hands). Before the surgery, physical therapy was implemented (96% cases) and the patients were frequently on a sick leave (42% cases). Imme- diately before the surgery, the patients suffered intensive pain (median 7 on a 0–10 scale), and had a reduced hand function (median 2 on a 0–10 scale). After the surgery (6–12 months), the pain was reduced (difference –5.0, 95% CL –5.5, –4.5, p<0.001), and the function improved (difference 4.5, 95% CLs 4.0, 5.0, p<0.001). Longer time interval between referral to a primary care physician and referral to an orthopeadic surgeon (>1 year in 48% of the cases) was an independent negative predictor for these outcomes. Total difference in costs for sick leaves and physical therapies between the pre- and postopera- tive periods was estimated at approximately 269.030,00 to over 375.315,00 euros. The time between the entrance into the healthcare system and recognition of the need for surgical treatment of CTS needs to be reduced in order to get better medical and economic results.

Volumen: 5-6, 2006

Liječ Vjesn 2006;128:143–149

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