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Revision Rates for Carpal Tunnel Release after Endoscopic and Open Techniques in New York State are Equal
Christopher D Lopez, BA1, Siddharth Mahure, MD2; Brandon Shulman, MD2; John T. Capo, MD2; Jacques Henri Hacquebord, MD2
1Icahn School of Medicine at Mount Sinai, New York, NY; 2NYU Hospital for Joint Diseases, New York, NY
Introduction: The incidence of revision Carpal Tunnel Release (CTR) after failed endoscopic and open techniques has been reported to range from 1-22.5% and 0-19%, respectively. In addition to being highly variable, these revision rates originated from relatively small and/or single surgeon studies. In the current study, the New York Statewide Planning and Research Cooperative System (SPARCS) is used to investigate the frequency of primary and endoscopic CTR and revision surgery rates, related to the use of primary open versus endoscopic techniques. We hypothesize that there is an increased rate of revision CTR after endoscopic compared to open CTR.
Methods: The SPARCS database was used to search for all patients that underwent carpal tunnel release from 2003-2014 (57,670 patients). Assessment included annual rates of primary CTR, revision CTR, and time to revision CTR following endoscopic and open techniques with a minimum of 2 year follow up. Subgroup analyses of age, gender, insurance status, and concomitant ulnar nerve involvement in procedure were performed.
Results: From 2003-2012, primary endoscopic CTR increased by 333% while primary open CTR increased by 195%. As a proportion of all primary CTR, endoscopic CTR increased from 42.6% (2003) to 55.9% (2012). With a 2 year minimum follow up, revision rates between endoscopic and open CTR did not show a clinically or statistically significant difference (0.97% and 1.0%, respectively with p=0.359). When ulnar nerve decompression at the elbow was also performed at initial CTR, revision rates were significantly different (open: 0.57% & endoscopic: 1.42%, p=0.0331). Patients undergoing endoscopic CTR returned for revision on average 4 months earlier than open CTR patients (15.76 months versus 19.64 months p = 0.05).
Discussion: To our knowledge, CTR revision rates in a large population has not been reported in the literature. Contrary to our hypothesis, revision rates after primary endoscopic CTR were not increased compared to primary open CTR. However, when the initial CTR procedure included release of the ulnar nerve at the elbow for concomitant cubital tunnel syndrome, there were significantly higher rates of revision CTR following endoscopic CTR as compared to open CTR. Of note, patients underwent revision surgery earlier when the initial release was performed endoscopically. There are limitations when using large databases, but the findings support the argument that endoscopic CTR does not increase the need for revision CTR. However, when cubital tunnel syndrome is present concomitantly alongside carpal tunnel syndrome, this may serve as a relative contraindication for performing an endoscopic CTR.
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