Gender representation and reimbursement trends in cubital tunnel surgery: a retrospective review of Medicare data from 2013 to 2022.

Background: Cubital tunnel syndrome is the second most common upper extremity neuropathy and is frequently managed with surgical decompression. While gender disparities have been shown to extend into Medicare reimbursement rates, this has not yet been evaluated among surgeons performing cubital tunnel surgery. This study examines trends among surgeon gender and geographical regions in cubital tunnel surgery volume, reimbursement rates, and patient demographics from 2013 to 2022. Methods: The "Medicare Physician & Other Practitioners-by Provider and Service" dataset was queried for billings of cubital tunnel surgery from 2013 to 2022. Reimbursement rates, surgery volume, patient demographics, and surgeon characteristics were extracted for analysis. The Welch t-test was used to assess for differences based on surgeon gender. Results: From 2013 to 2022, female surgeons performed 8.5% of the 60,029 cubital tunnel surgeries billed to Medicare Part B, with the overall proportion of female surgeons increasing from 4.6% to 9.9%. The largest growth occurred in the Midwest, while there were declines in the Northeast and West. Female surgeons saw a 282.5% increase in surgeries compared to 53.3% for males, and the number of surgeries per female surgeon rose by 30.9%. Patient demographics did not significantly differ over the study period. Reimbursement decreased for all surgeons, with males seeing a 17.7% decrease and females 20.3%, averaging $435 for males and $435.35 for females ( Conclusion: Female surgeon representation in cubital tunnel surgeries increased from 2013 to 2022 but remains under 10%. Though reimbursement does not differ by gender, disparities in procedural volume and regional representation highlight the need to understand systemic and institutional factors to promote equity.