Postoperative Morbidity Following Carpal Tunnel Release Surgery: A NSQIP Analysis
Matthew Rich, MD, Victor Vakayil, MBBS, MS, Christopher Stewart, MD, Ashish Mahajan, MD, Umar Choudry, MD, Nicholas Kim, MD.
University of Minnesota, Minneapolis, MN, USA.
PURPOSE: Carpal Tunnel Syndrome (CTS) is common neuropathy among adults with yearly incidence of approximately 900,000 new cases in the United States. We leverage a national surgical outcomes database to evaluate the rate of postoperative infections and identify patient-related risk factors associated with postoperative morbidity.
We performed a 13-year (2005-2017), retrospective cohort analysis of the American College of Surgeon National Quality Improvement Program database. Using International Classification of Disease-9 and-10 Codes along with Current Procedure Terminology Codes, we identified all patients with CTS undergoing open or endoscopic surgery. We reviewed baseline patient demographics, comorbidities, laboratory values, operating specialty, and perioperative variables. Our primary outcome was 30-day postoperative rate of any surgical site complications (SCC) defined by the presence of any superficial, deep or organ space infection along with any episode of wound dehiscence. Secondary outcomes included 30-day rates of any other infectious and noninfectious complications. We performed a univariate analysis and constructed a multivariate logistic regression model to identify all risk factors independently associated with our primary outcome.
We identified a total of 1305 patients who underwent CT surgery, 64.7% (N=844) of patients were female, 63.2% (N=825) were Caucasian, 12.2% (159) were African American with an average BMI of 32.3 ± 8.2 kg/m2. 78% (N=1018) of repairs were performed by orthopedic surgeons, and 14.1% (N=184) by plastic surgeons. Though not statistically significant the complication rate was highest among plastic surgeons and lowest among general surgeons. Overall SCC was 1.5% (N=21). Rates of other infectious and noninfectious were also low: 0.2% (N=3). Unplanned reoperation rates were 0.5% (N=7). On univariate analysis comorbidities such as diabetes, smoking status, obesity, alcohol consumption was not associated with an increased rate of SCC, however, higher ASA scores, history of severe dyspnea, chronic obstructive pulmonary disease (COPD), and chronic use of systemic or local steroids increased the risk for surgical site infection and wound dehiscence (all P values < 0.05). On multivariate analysis we observed that history of COPD (OR 5.2, 95% CI: 1.6-9.2, P = 0.014) and chronic systemic or local steroid use (OR 5.3, 95% CI: 1.2-8.7, P 0.034) was independently associated with a higher odd of postoperative morbidity.
CTS is safe and overall wound complication rates remain low; conventional preoperative risk factors such as smoking, diabetes, increased BMI etc, failed to show an association with postoperative morbidity.
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