Racial and Ethnic Differences in Carpal Tunnel Syndrome Management: Analysis of a National Single-payer System.

Background: Carpal tunnel syndrome is the most common entrapment neuropathy. Prior studies have documented racial and ethnic disparities in use of carpal tunnel release (CTR), but few have examined differences in the use of both operative and nonoperative treatments and differences in an equal-access healthcare system. Methods: We conducted a retrospective cohort study of 366,009 veterans diagnosed with carpal tunnel syndrome across the Veterans Health Administration from 2010 to 2020. We assessed the association of race/ethnicity with receipt of CTR, surgical consultation, nonoperative management modalities, and time to treatment using multilevel logistic regression and Cox proportional hazards models. Predictors included demographic, clinical, structural, and care process variables. Results: Among the study cohort, 12.7% underwent CTR within 2 years. After adjustment, Black and Hispanic veterans had significantly lower odds of receiving CTR compared with White veterans (Black: odds ratio 0.61; Hispanic: odds ratio 0.80). Similar trends were observed for surgical consultation, although the magnitude of disparity was attenuated. Time-to-event analyses showed prolonged time to surgical consultation and CTR for Black and Hispanic veterans compared with White veterans. Black and Hispanic patients were more likely to receive nonoperative treatments, including splinting and specific therapeutic modalities. Conclusions: Despite the Veterans Health Administration's equal-access model, significant racial and ethnic differences exist in surgical consultation, receipt of CTR, and timeliness of care. These differences seem to emerge across the surgical care continuum and are not fully explained by clinical or structural factors. Interventions targeting pre- and perioperative processes are needed to ensure equitable surgical care delivery.