Abstract
SummaryBackgroundCarpal tunnel decompression surgery to treat carpal tunnel syndrome is a common procedure, yet data on safety and effectiveness of the operation in the general population remain scarce. We aimed to estimate the incidence of reoperation and serious postoperative complications (requiring admission to hospital or further surgery) following carpal tunnel decompression in routine clinical practice and to identify the patient factors associated with these adverse outcomes.MethodsWe did a nationwide cohort analysis including all carpal tunnel decompression surgeries in patients aged 18 years or older, done in the National Health Service in England between April 1, 1998, and March 31, 2017, using the Hospital Episode Statistics dataset linked to mortality records. Patients were followed-up until death or until the end of the study (March 31, 2017). Primary outcomes were the overall incidence of carpal tunnel decompression reoperation and serious postoperative complications (surgical site infection or dehiscence, or neurovascular or tendon injury, requiring admission to hospital or further surgery) within 30 days and 90 days after surgery. Multivariable Cox regression analysis was used to identify factors influencing complications and reoperation, and the Fine and Gray method was used to adjust for the competing risk of mortality. This study is registered with ClinicalTrials.gov, NCT03573765.Findings855 832 carpal tunnel decompression surgeries were done between April 1, 1998, and March 31, 2017 (incidence rate 1·10 per 1000 person-years [95% CI 1·02–1·17]). 29 288 procedures (3·42%) led to carpal tunnel decompression reoperation (incidence rate 3·18 per 1000 person-years [95% CI 3·12–3·23]). Of the 855 832 initial surgeries, 620 procedures (0·070% [95% CI 0·067–0·078]) led to a serious complication within 30 days after surgery, and 698 procedures (0·082% [0·076–0·088]) within 90 days. Local complications within 90 days after surgery were associated with male sex (adjusted hazard ratio 2·32 [95% CI 1·74–3·09]) and age category 18–29 years (2·25 [1·10–4·62]). Male sex (adjusted subhazard ratio 1·09 [95% CI 1·06–1·13]), old age (>80 years vs 50–59 years: 1·09 [1·03–1·15]), and greater levels of comorbidity (Charlson score ≥5 vs 0: 1·25 [1·19–1·32]) and socioeconomic deprivation (most deprived 10% vs least deprived 10%: 1·18 [1·10–1·27]) were associated with increased reoperation risk.InterpretationTo our knowledge, this is the largest national study on carpal tunnel decompression to date, providing strong evidence on serious postoperative complication and reoperation rates. Carpal tunnel decompression appears to be a safe operation in most patients, with an overall serious complication rate (requiring admission to hospital or further surgery) of less than 0·1%.FundingVersus Arthritis; Medical Research Council; Royal College of Surgeons of England and National Joint Registry research fellowship; University of Oxford; National Institute for Health Research; and National Institute for Health Research Biomedical Research Centre, Oxford.
Highlights
Carpal tunnel syndrome is the most common peripheral entrapment neuropathy, caused by compression of the median nerve within the carpal tunnel at the level of the wrist
Estimates of prevalence range between 5% and 10%, with patients presenting to both primary care physicians and secondary care specialists.[1,2]
In the USA, symptomatic carpal tunnel syndrome is reported within government statistics as being the second leading cause of prolonged workplace absence.[3]
Summary
Carpal tunnel syndrome is the most common peripheral entrapment neuropathy, caused by compression of the median nerve within the carpal tunnel at the level of the wrist. Estimates of prevalence range between 5% and 10%, with patients presenting to both primary care physicians and secondary care specialists.[1,2] In the USA, symptomatic carpal tunnel syndrome is reported within government statistics as being the second leading cause of prolonged workplace absence.[3] Symptoms include pain in the wrist, tingling and numbness in the median nerve distribution, and in severe cases, thumb weakness, leading to functional disability in the hand.[4]. Initial management is non-surgical, but many patients require surgery to decompress the carpal tunnel and preserve hand function.[2,5] Carpal tunnel decompression surgery is widely undertaken but poorly evaluated, and estimates of complication rates vary widely.[6,7,8] Results highlighted by the Cochrane collaboration have shown that less than 3000 hands have ever been included in any randomised clinical trial involving carpal tunnel surgery, with the majority of trials exploring the role of endoscopic
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
