PURPOSE: This study compared postoperative complications and revision rates following endoscopic versus open carpal tunnel release (CTR) in obese and nonobese patients.
METHODS: A 2010-2022 national administrative database was queried to identify adults undergoing open or endoscopic CTR. Patients undergoing open and endoscopic CTR were each matched 1:1 for age, sex, diabetes, tobacco use, and Elixhauser Comorbidity Index in both the obese (body mass index > 30 kg/m2) and nonobese cohorts. Ninety-day complications and ipsilateral revision surgery within 5 years were compared using univariable and multivariable analysis for each cohort.
RESULTS: In the obese matched cohort, endoscopic CTR was associated with lower rates of surgical site infection (0.46% vs 0.73%) and wound dehiscence (0.39% vs 0.72%) compared with open CTR (all P < .001). There was no significant difference in revision rates between endoscopic and open CTR (1.92% vs 2.01%, P = .466). On multivariable analysis, these associations remained significant (surgical site infection OR 0.62, 95% confidence interval [CI] 0.49-0.76 and wound dehiscence OR 0.53, 95% CI 0.42-0.67, all P < .001). In the nonobese cohort, endoscopic CTR was similarly associated with reduced rates of surgical site infection (0.30% vs 0.48%) and wound dehiscence (0.19% vs 0.40%) with corresponding reduced odds of surgical site infection (OR 0.64, 95% CI 0.59-0.70) and wound dehiscence (OR 0.47, 95% CI 0.43-0.52) (all P < .001). Revision rates were slightly higher in endoscopic versus open CTR (1.49% vs 1.39%, P = .007) for nonobese patients. There were no differences in hematoma or median nerve injuries in either cohort.
CONCLUSIONS: Endoscopic CTR was associated with a decrease in wound complications in both obese and nonobese patients. There were comparable rates of revision surgery and median nerve injuries between the 2 surgical approaches. However, the clinical differences were modest, and the choice of surgical approach may remain at the discretion of the treating surgeon.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IIb (Oxford CEBM Level 2b. Retrospective comparative cohort study).
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