Safety and cost savings of non-theatre carpal tunnel release: observational analysis of administrative data for England

Introduction: Carpal tunnel release (CTR) surgery is typically performed in resource-intensive operating theatres. Transitioning CTR to procedure or clinic rooms may reduce costs, waiting times and environmental impact. This study evaluated the clinical safety and financial savings associated with CTR surgery performed outside traditional theatre settings. Methods: An observational, retrospective analysis was conducted using Hospital Episode Statistics data from England between April 2017 and September 2024, comparing patients undergoing CTR in trusts predominantly using non-theatre settings with those trusts predominantly using operating theatres. Primary outcomes were emergency readmission within 30 days and ipsilateral repeat surgery within 1 year. Logistic regression models adjusted for age, sex, socioeconomic deprivation, frailty and year of surgery. The financial implications associated with this move away from theatres were analysed using structured interviews and national procurement prices. Results: In total, 5748 patients (four hospital trusts) were included in the non-theatre group and 223,463 patients (137 hospital trusts) were in the operating theatre group. Carpal tunnel release performed by trusts routinely performing it outside theatres was not associated with higher risk of repeat ipsilateral surgery within 1 year or 30-day all-cause emergency readmission. Non-theatre settings reduced cost per procedure by around 40%. Conclusions: Carpal tunnel release surgery performed in non-theatre settings was not associated with higher rates of 30-day all-cause emergency readmissions or 12-month revision rates. Estimated financial costs were substantially lower for out-of-theatre CTR based on data for two trusts routinely performing CTR out of theatre. Wider adoption of this model could enhance operational efficiency. Level of evidence: III