Simple decompression or anterior subcutaneous transposition for ulnar neuropathy at the elbow: A cost-minimization analysis - Part 2

Canisius-Wilhelmina Ziekenhuis, Nymegen, Gelderland, Netherlands
Neurosurgery (Impact Factor: 3.03). 04/2005; 56(3):531-6; discussion 531-6. DOI: 10.1227/01.NEU.0000154132.40212.6E
Source: PubMed

ABSTRACT A randomized controlled trial was reported recently, in which simple decompression and anterior subcutaneous transposition were compared for treatment of ulnaropathy at the elbow. Clinically, both surgical options seem to be equally effective. The objective of this study is to compare the costs, from a societal standpoint, of simple decompression versus anterior subcutaneous transposition in Euros.
Published and unpublished data from a randomized controlled trial that compared simple decompression and anterior subcutaneous transposition were used. The investigators tabulated the actual costs incurred for professional fees, use of the operating room, duration of sick leave, reintervention, and treatment of complications directly related to the surgical treatment.
The total costs per group and per patient were statistically significantly less for those treated with simple decompression. The total median costs per patient were 1124 Euros for simple decompression and 2730 Euros for anterior subcutaneous transposition. The main difference was in the costs related to sick leave, which is significantly shorter for simple decompression. There also was a statistically significant difference in operation time in favor of simple decompression. A remarkable finding was that paid workers in both treatment groups returned to work much later than unpaid workers.
Although clinically equally effective, simple decompression was associated with lower cost than anterior subcutaneous transposition for the treatment of ulnar neuropathy at the elbow. Compared with anterior subcutaneous transposition, we recommend simple decompression for the treatment of idiopathic ulnar neuropathy at the elbow.

Download full-text


Available from: Wim Verhagen, Jul 06, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The outcome of decompression for long-standing symptoms of nerve entrapments in the proximal forearm was investigated in a retrospective study of 205 patients using a self-assessment questionnaire, 45 months after the operation. The questionnaire consisted of visual analogue scale recordings of pre- and postoperative pain during rest and activity, questions about remaining symptoms and appreciation of the result and the Disabilities of Arm, Shoulder and Hand form (DASH). Altogether, 59% of the patients were satisfied, 58% considered themselves improved, and 3% as being entirely relieved of all symptoms. Pain decreased significantly (P = 0.001). There was a significant correlation between preoperative duration and patient perceived post-operative pain. Preoperative pain was a chief complaint, and pain reduction appears to be the principal gain of the operation. Although the majority of the patients benefited from the operation, a substantial proportion was not satisfied. There is apparently room for improvement of the diagnostic and surgical methods applied in this study.
    01/2011; 2011:727689. DOI:10.4061/2011/727689
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The decision-making process in the diagnosis and treatment of an ulnar nerve entrapment (UNE) at the elbow is presented from the viewpoint of the patient and from that of a physician who in this case, were the same individual. The problems of diagnosis and the selection of the appropriate therapy-conservative or surgical and the choice of a particular surgical approach are discussed in the light of recent evidence-based medicine (EMB) literature.
    Hand 03/2009; 4(4):350-6. DOI:10.1007/s11552-009-9176-9
  • [Show abstract] [Hide abstract]
    ABSTRACT: The repetitive and stressing movements by athletes [1–5], wheelchair users [6], and manual workers [7–9] can cause overwork syndromes of articular and periarticular musculo-tendinous structures [10]. Terms like “lateral” and “medial epicondylalgia” characterize painful syndromes in the elbow, due to microtraumatic stress in the medial region (internal compartment) and in the lateral region (external compartment).