Exploring the Impact of Preoperative Laboratory Values on Short-Term Outcomes in Complex Carpal Tunnel Decompression Surgery.

Abstract

Background: The present study analyzes the effects of preoperative serum albumin, hematocrit, and creatinine on postoperative outcomes in patients undergoing carpal tunnel decompression surgery. Methods: The American College of Surgeons National Quality Improvement Program (NSQIP) database was queried from 2011 to 2020. Albumin, hematocrit, and creatinine were collected for each patient, alongside covariates. Outcomes included 30-day medical complications, 30-day wound complications, return to the operating room, nonhome discharge, and extended postoperative length of stay. Bivariate t-tests and multivariate logistic regressions were conducted. For any outcome-laboratory value pairs with significance on regression, area under the receiver operating characteristic curves (AUC) were constructed. Results: A total of 1440 patients with albumin, 3138 patients with hematocrit, and 3159 patients with creatinine levels were identified. Increased serum albumin was associated with lower odds of medical complications (aOR: 0.479, p=0.035). An overall cohort cutoff of ≤ 3.5 g/dL (AUC: 0.79, p < 0.001) was predictive of medical complications. On multivariate logistic regression, increased hematocrit reduced the odds of medical complications (aOR: 0.889, p < 0.001). Predictive hematocrit cutoffs of ≤ 39.7% (AUC: 0.77, p < 0.001) and ≤ 36.6% (AUC: 0.74, p < 0.001) were identified for medical complications amongst male and female patients, respectively. Similarly, increased serum creatinine was associated with greater odds of medical complications (aOR: 1.684, p=0.006). Creatinine cutoffs of ≥ 1.2 mg/dL (AUC: 0.58, p=0.033) and ≥ 1.0 mg/dL (AUC: 0.59, p=0.039) were identified for medical complications amongst male and female patients, respectively. Conclusions: Multiple preoperative serum values were predictive of postoperative medical complications, and laboratory value thresholds were identified in this carpal tunnel decompression cohort to aid in risk stratification.