Differences in Volume, Reimbursement, Practice Styles, and Patient Characteristics Between Male and Female Surgeons for Open and Endoscopic Carpal Tunnel Release.

Background: The goal of this study was to evaluate differences in carpal tunnel release volume, reimbursement, practice styles, and patient populations between male and female surgeons from 2013 to 2021.

Materials and methods: The Medicare Physician & Other Practitioners database was queried from 2013 to 2021. Procedure volume, reimbursement, surgeon information, and patient demographic characteristics were collected for any surgeon who performed at least 10 open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) procedures that year. The Welch t test, the Kruskal-Wallis test, and multivariable linear regressions were conducted to compare male and female surgeons and analyze geographic and annual differences.

Results: From 2013 to 2021, the proportion of carpal tunnel releases performed by female surgeons increased for OCTR by 4.5% (7.1% to 11.6%) and for ECTR by 3.3% (4.8% to 8.1%). Female OCTR surgeons on average had fewer beneficiaries per surgeon (443.37 vs 354.20, P<.001), performed fewer billable services per beneficiary (6.37 vs 5.35, P=.03), and performed fewer unique billable services (91.13 vs 77.79, P<.001) compared with male surgeons. Female OCTR surgeons also saw a lower percentage of White patients (88.14 vs 86.48, P=.003) and a higher percentage of female patients (60.06 vs 61.70, P<.001) and dual-enrolled Medicare-Medicaid patients (10.54 vs 11.22, P=.046).

Conclusion: Female representation among OCTR and ECTR surgeons increased across the country. Male OCTR surgeons billed for more services and performed more services per beneficiary and also treated a higher proportion of White patients and dual Medicare-Medicaid enrollees compared with female surgeons. Future studies are required to identify reasons for and ways to address these disparities. [Orthopedics. 2025;48(1):57-63.].