Amyloidosis and Biopsy During Carpal Tunnel Release: A Survey of American Society for Surgery of the Hand Members.

Abstract

Our purpose was to assess the current surgical practices of hand surgeons with respect to carpal tunnel release (CTR) and biopsy for amyloidosis. In addition, we aimed to determine whether surgeon demographic factors were associated with higher rates of biopsy during CTR. An anonymous, multiple-choice survey was distributed to all active American Society for Surgery of the Hand members, which included baseline demographic questions. Using a five-point Likert scale, the respondents were asked how frequently they obtain biopsies during CTR cases meeting tier 1 and tier 2 criteria. Questions related to biopsy techniques, CTR techniques, referral patterns, and billing practices were also administered. Bivariate comparisons were made to assess the relationship between surgeon demographics and the likelihood of having ever performed a biopsy. Of the 3,903 distributed surveys, 643 (16%) responded. Thirty-nine percent stated that they "never" perform a biopsy for tier 1 criteria, 32% responded "rarely," and 8% responded "always." Forty-six percent of the surgeons performed endoscopic carpal tunnel release; however, only 53% of surgeons using endoscopic carpal tunnel release did so to obtain biopsies. Fifty-nine percent of respondents stated that they "always" refer patients with evidence of amyloid deposition on biopsy to a cardiologist. Surgeons in academic practice models were significantly more likely to have ever performed biopsies on patients with tier 1 criteria compared with nonacademic surgeons (70% vs 59%). However, years in practice, residency training, and practice location were not associated with a higher likelihood of having ever performed a biopsy. The frequency of biopsy for amyloid during CTR appears low among the American Society for Surgery of the Hand members. Although surgeons in academic settings were more likely to perform a biopsy during CTR, no other demographic factors were associated with higher biopsy rates. Understanding current practice patterns may aid in devising screening strategies and can inform both evidence-based management guidelines and care pathways.