Early Rates of Revision Surgery in Endoscopic and Open Carpal Tunnel Release.

Purpose: To compare rates of revision surgery between primary endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). In addition, we aimed to assess the influence of fellowship training on revision rates. We hypothesized that ECTR would not be associated with higher rates of revision surgery.

Methods: We conducted a retrospective, single-center replication study of a recently published comparative assessment of ECTR and OCTR. All patients between 18 and 75 years old undergoing primary ECTR or OCTR over a 6-year period were included if they were seen within 1 year after surgery. To control for confounding, adjusted binary logistic regression models were inverse-weighted by propensity scores. Early (12 months) and overall revision rates were compared between ECTR and OCTR, as were revision rates relative to surgeon training.

Results: A total of 4,160 patients and 63 surgeons were included. Eighty-one percent underwent OCTR. Nine patients (0.21%) underwent revision within 12 months of index CTR at a mean of 231 days postoperatively. The early revision rate for OCTR and ECTR were 0.24% and 0.13%, respectively. After adjusting for patent characteristics and confounding, ECTR cases were 0.28 times (95% confidence interval, 0.09-0.90) less likely to undergo revision. Early OCTR revision rates for hand surgeons were similar to nonhand surgeons (0.23% vs 0.24%); however, statistically significant higher revision rates were noted for nonhand surgeons (1.04%) compared to hand surgeons (0.42%) for revisions beyond 12 months.

Conclusions: Within a single health care system, the early revision rate after primary CTR was 0.21%. When adjusting for patient characteristics and controlling for confounding, ECTR was 0.28 times less likely to undergo revision compared to OCTR. Hand fellowship training was associated with lower OCTR revision rates beyond 1 year. These data highlight the need for future investigations to clearly define indications for, and outcomes following, revision CTR.

Type of study/level of evidence: Prognostic II.