Is Glycemic Control and Surgical Approach Related to Surgical Site Infection Following Carpal Tunnel Release?

PURPOSE: Although poor glycemic control has been shown to be a risk factor for surgical site infection (SSI) for many elective musculoskeletal procedures, this association in the setting of carpal tunnel release (CTR) is unclear in the existing literature.

METHODS

A chart review was performed on 1,000 consecutive patients who underwent elective endoscopic or open CTR. Patient characteristics such as diabetic status, insulin dependence, HbA1c levels within 6 months of surgery, perioperative antibiotics, and diagnosis of SSI were obtained from the electronic medical record.

RESULTS

Mean age was 52 years (SD, 14 years; range, 18-94). SSI occurred in 20 patients with an overall rate of 2%. Six hundred and sixty-eight (67%) surgeries were performed endoscopically, and 332 (33%) were open. HbA1c levels within 6 months of surgery were reported in 453 with a mean value of 6.2 (SD, 1.2). Perioperative antibiotics were given in 555 of 1,000 (56%) patients. Univariate analysis found that open surgery had higher rates of SSI (3.9%) than endoscopic (1.0%). There was no association between SSI and HbA1c levels, diabetic status, insulin dependence, or administration of perioperative antibiotics. After controlling for diabetic status, insulin dependence, and perioperative antibiotics using multivariable logistic regression, open surgery continues to have increased odds of SSI. In total, 17 of 20 (85%) of the cases with SSI were successfully treated with oral antibiotics, whereas the remaining three underwent irrigation and debridement.

CONCLUSIONS

SSI following CTR was not found to be associated with HbA1c levels, diabetic status, or perioperative antibiotic use. Open surgery was an independent predictor of SSI. However, SSI was often diagnosed without documented objective criteria, and incidence did not differ by approach when only objective criteria were fulfilled. Rates of SSI were low overall, with most cases successfully treated with oral antibiotics.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.