Does Revision Carpal Tunnel Release Result in Long-Term Outcomes Equivalent to Single Carpal Tunnel Release? A Matched Case-Control Analysis

• Published in: Plastic and reconstructive surgery (1963) Vol. 153; no. 4; p. 746e
• Main Authors: Westenberg, Ritsaart F, DiGiovanni, Peter L, Schep, Niels W L, Eberlin, Kyle R, Chen, Neal C, Coert, J Henk
• Format: Journal Article
• Language: English
• Published: United States 01.04.2024
• Subjects: Carpal Tunnel Syndrome - complications; Carpal Tunnel Syndrome - surgery; Case-Control Studies; Humans; Pain; Patient Reported Outcome Measures; Retrospective Studies; Wrist
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0000000000010682

The aims of this study were to evaluate long-term patient-reported outcomes after revision carpal tunnel release (CTR); compare these outcomes with those of patients who had a single CTR and a comparable age, sex, race, type of initial surgery, and follow-up time; and assess which factors are associated with worse patient-reported outcomes after revision CTR. The authors retrospectively identified 7351 patients who had a single CTR and 113 patients who had a revision CTR for carpal tunnel syndrome between January of 2002 and December of 2015 at five academic urban hospitals. Of these 113 revision CTR cases, 37 patients completed a follow-up questionnaire including the Boston Carpal Tunnel Questionnaire (BCTQ), the Numerical Rating Scale for Pain Intensity, and satisfaction score. Those who completed the follow-up questionnaire were randomly matched to five controls (patients who had a single CTR) based on age, sex, race, type of initial surgery, and follow-up time. Of these 185 matched controls, 65 completed the follow-up questionnaire. A linear mixed effects model using matched sets as a random effect showed that patients who had a revision CTR had a higher total BCTQ score, Numerical Rating Scale for Pain Intensity score, and a lower satisfaction score at time of follow-up than patients who had a single CTR. Multivariable linear regression showed that thenar muscle atrophy before the revision surgery was independently associated with more pain after revision surgery. Patients improve after revision CTR, but generally have more pain, have a higher BCTQ score, and are less satisfied at long-term follow-up compared with patients who had a single CTR.