BACKGROUND: Few studies have investigated the outcomes of carpal tunnel release (CTR) in patients with rheumatic disease. The aim of this study was to determine the predictive factors associated with increased complication and reoperation rates in this population. METHODS: Between 2018 and 2020, 1694 patients underwent CTR at our institution. After manually reviewing the medical records, the authors identified 128 patients with autoimmune rheumatic disease who underwent CTR. Univariate regression analysis was performed to study association with demographics (age, sex, race), comorbities (smoking, diabetes, hypothyroidism, cervical radiculopathy, obesity), unilateral or bilateral treated wrist(s), type of surgery (open or endoscopic), and preoperative severity as determined by electromyography studies. RESULTS: One hundred twenty eight of 1694 patients (7.6%) had autoimmune rheumatic disease including rheumatoid arthritis (n = 68, 53.1%), Sjogren’s syndrome (n = 13, 10.2%), psoriasis (n = 38, 29.7%), vasculitis (n = 22, 17.2%), dermatomyositis (n = 2, 1.6%), inflammatory bowel disease (n = 13, 10.2%), lupus (n = 9, 7%), systemic scleroderma (n = 2, 1.6%). Three patients received CTR revision (2.3%). There were 24 total complications (18.8%) including prolonged postoperative pain and paresthesia (n = 20, 83.3%), surgical site infection (n = 3, 12.5%), wound dehiscence (n = 1, 4.2%), and surgical reoperation (n = 1, 4.2%). Univariate analysis demonstrated no demographic factors, comorbidities, or open versus endoscopic surgery were predictive of increased complication rate or revision CTR rates in the rheumatic disease population. CONCLUSION: Autoimmune rheumatic disease is associated with higher rates of CTR revision than the general population. As compared to factors significant for higher risk of revision surgery in the normal population, older age, male sex, bilateral CTR, and endoscopic CTR were not associated with higher odds for revision surgery.