Endoscopic Versus Open Carpal Tunnel Release in 17,700 Obese Patients: A Propensity-matched Cohort Study.

BACKGROUND

In obese patients, short-term outcomes after endoscopic versus open carpal tunnel release (CTR) are not well defined.

METHODS

TriNetX was queried for obese adults undergoing CTR. Propensity score matching (1:1) on demographics, body mass index, comorbidities, and medication exposures produced balanced cohorts for 30-day outcomes (8850 per group) and 90-day outcomes (8606 per group). Outcomes were assessed at 30 and 90 days and reported as risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

Endoscopic CTR demonstrated lower wound morbidity than open CTR, with reduced wound disruption at 30 days (RR 0.339, 95% CI 0.207-0.555) and 90 days (RR 0.341, 95% CI 0.224-0.519) and reduced infection at 30 days (RR 0.237, 95% CI 0.133-0.425) and 90 days (RR 0.341, 95% CI 0.223-0.524) (all P < 0.001). At 90 days, endoscopic CTR also showed lower sepsis (RR 0.500, P = 0.014) and pulmonary embolism (RR 0.435, P = 0.024). Readmissions were lower at 30 days (RR 0.414, 95% CI 0.372-0.461) and 90 days (RR 0.513, 95% CI 0.472-0.556) (both P < 0.001). Revision procedures were more common at 30 days (RR 1.276, 95% CI 1.172-1.389) and 90 days (RR 1.178, 95% CI 1.097-1.265) (both P < 0.001). Differences in deep vein thrombosis, acute kidney injury, myocardial infarction, stroke, pneumonia, urinary tract infection, stiffness, and mortality were not significant.

CONCLUSIONS

Endoscopic CTR in obese patients is associated with fewer short-term wound complications and fewer readmissions than open CTR, though revision procedures were more frequent.