142 Simultaneous Versus Staged Bilateral Carpal Tunnel Release Surgeries: A Retrospective Propensity-Matched Patient Comorbidity Analysis

Abstract

INTRODUCTION: Carpal Tunnel Entrapment is the most common peripheral neuropathy, accounting for ∼ 90% of all neuropathies and frequently, occurs bilaterally. While thousands of carpal tunnel releases are performed each year bilaterally, the current understanding of pre-operative factors and postoperative outcomes in simultaneous and staged bilateral carpal tunnel release remain poor. METHODS: We performed a retrospective database analysis of the TriNetX database, consisting of 92 health care networks throughout the United States. Patients were divided into two cohorts: individuals with simultaneous bilateral carpal tunnel release and individuals with staged carpal tunnel releases within 3 months of each other. Numerous pre-operative comorbidities were evaluated for surgical determination and then, matched via propensity score matching. Post-operative outcomes were measured within 180 of surgery with and without propensity score matching. Statistical analysis was done through TriNetX software, which utilizes JAVA, R, and Python programming languages. RESULTS: The two cohorts result in 17,513 patients for staged carpal tunnel releases and 9,649 for simultaneous bilateral carpal tunnel release surgery. After propensity score matching, 9,289 patients were used in the analysis. Overall, those that underwent staged surgeries had more pre-operative co-morbidities (Hypertension, obesity, chronic kidney disease, arthritis, etc.). Upon matching, patients with staged releases had significantly higher postprocedural aftercare (OR 2.023; 1.813, 2.258), hand/ joint pain (OR 1.876; 1.212-2.905), pain in the extremity (OR 1.161; 1.055, 1.277), trigger finger (OR 1.608; 1.387-1.865), and an upper respiratory tract infection (OR 1.366; 1.206-1.546). Patients with simultaneous bilateral carpal tunnel release had more emergency room visits (OR .835; .766-.91). Non-significant outcomes pulmonary or venous embolism, intraoperative complications, hematomas, surgical site infection, and rehospitalizations. CONCLUSION: These findings demonstrate selection variance between simultaneous and staged carpal tunnel releases. Even after matching, simultaneous bilateral carpal tunnel releases provide fewer post-operative complications while only showing a mild increase in emergency room visits. Further prospective studies could be used to validate these results as well as provide new findings to the management and treatment of these groups.