Endoscopic Versus Open Carpal Tunnel Release in 17,700 Obese Patients: A Propensity-matched Cohort Study
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Background: In obese patients, short-term outcomes after endoscopic versus open carpal tunnel release (CTR) are not well defined. Methods: TriNetX was queried for obese adults undergoing CTR. Propensity score matching (1:1) on demographics, body mass index, comorbidities, and medication exposures produced balanced cohorts for 30-day outcomes (8850 per group) and 90-day outcomes (8606 per group). Outcomes were assessed at 30 and 90 days and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Results: Endoscopic CTR demonstrated lower wound morbidity than open CTR, with reduced wound disruption at 30 days (RR 0.339, 95% CI 0.207–0.555) and 90 days (RR 0.341, 95% CI 0.224–0.519) and reduced infection at 30 days (RR 0.237, 95% CI 0.133–0.425) and 90 days (RR 0.341, 95% CI 0.223–0.524) (all< 0.001). At 90 days, endoscopic CTR also showed lower sepsis (RR 0.500,= 0.014) and pulmonary embolism (RR 0.435,= 0.024). Readmissions were lower at 30 days (RR 0.414, 95% CI 0.372–0.461) and 90 days (RR 0.513, 95% CI 0.472–0.556) (both< 0.001). Revision procedures were more common at 30 days (RR 1.276, 95% CI 1.172–1.389) and 90 days (RR 1.178, 95% CI 1.097–1.265) (both< 0.001). Differences in deep vein thrombosis, acute kidney injury, myocardial infarction, stroke, pneumonia, urinary tract infection, stiffness, and mortality were not significant. Conclusions: Endoscopic CTR in obese patients is associated with fewer short-term wound complications and fewer readmissions than op
Abstract
Background: In obese patients, short-term outcomes after endoscopic versus open carpal tunnel release (CTR) are not well defined. Methods: TriNetX was queried for obese adults undergoing CTR. Propensity score matching (1:1) on demographics, body mass index, comorbidities, and medication exposures produced balanced cohorts for 30-day outcomes (8850 per group) and 90-day outcomes (8606 per group). Outcomes were assessed at 30 and 90 days and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Results: Endoscopic CTR demonstrated lower wound morbidity than open CTR, with reduced wound disruption at 30 days (RR 0.339, 95% CI 0.207–0.555) and 90 days (RR 0.341, 95% CI 0.224–0.519) and reduced infection at 30 days (RR 0.237, 95% CI 0.133–0.425) and 90 days (RR 0.341, 95% CI 0.223–0.524) (all< 0.001). At 90 days, endoscopic CTR also showed lower sepsis (RR 0.500,= 0.014) and pulmonary embolism (RR 0.435,= 0.024). Readmissions were lower at 30 days (RR 0.414, 95% CI 0.372–0.461) and 90 days (RR 0.513, 95% CI 0.472–0.556) (both< 0.001). Revision procedures were more common at 30 days (RR 1.276, 95% CI 1.172–1.389) and 90 days (RR 1.178, 95% CI 1.097–1.265) (both< 0.001). Differences in deep vein thrombosis, acute kidney injury, myocardial infarction, stroke, pneumonia, urinary tract infection, stiffness, and mortality were not significant. Conclusions: Endoscopic CTR in obese patients is associated with fewer short-term wound complications and fewer readmissions than open CTR, though revision procedures were more frequent.