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Timing between Bilateral, Staged Carpal Tunnel Release and Associated Complication Risk
Jill G Putnam, MD; Stephanie Ferrante, MD; Alex Sheldon, BS; Roberto Gonzalez, MD
The Ohio State University, Columbus, OH
Introduction: We hypothesize that patients undergoing staged bilateral CTR in four weeks or less will have statistically significant higher complication rates than patients with a greater than 4-week interval. We also hypothesize that staged, bilateral carpal tunnel releases (CTR) will result in fewer complications than patients with simultaneous, bilateral CTR.
Materials & Methods: After Institutional Review Board Approval, a preliminary search of the billing records was conducted to identify patients treated surgically for CTR between 2011 and 2024 at a single institution. Retrospective chart review was then completed to identify patients with a staged procedure within one year and patients with a simultaneous surgery. Inclusion criteria included bilateral CTR, and minors and unilateral CTR were excluded. Patient factors analyzed included subject demographics, length of time between staged procedures, and any complications related to CTR. Complications evaluated included infection, dehiscence, or revision surgery. Statistical analysis was then performed to identify if there was a correlation between length of time between staged procedures and complication risk. Surgical site infection was grouped as either meeting CDC criteria for infection, or meeting attending's definition for infection that would benefit from antibiotics, within the 30-day post-operative period.
Results: The number of patients who fit the inclusion criteria were 726 staged patients and 93 simultaneous patients. Of these patients, 44 (6%) staged patients and 4 (4%) simultaneous patients were lost follow-up. 62 (9%) staged patients and 12 (13%) simultaneous patients experienced at least one complication. In the simultaneous group, 4 (4.5%) experienced dehiscence, 2 (2.2%) required a revision surgery, and none met the CDC definition of surgical site infection. Among the staged group, 26 (3.8%) experienced dehiscence, 5 (0.7%) required a revision surgery, and 6 (0.01%) met the CDC definition of surgical site infection. When evaluating There was no significant difference between staged procedures completed in greater than or less than 4 weeks (p = 0.30).
Conclusions: There was no statistically significant difference in overall complication rate between staged and simultaneous CTR procedures. There was no significant difference in overall complication rates between staged procedures completed in greater than or less than 4 weeks. If staging CTR, surgeons should have confidence scheduling the time between those procedures based on patient preference. Complication rates vary widely depending on definition of surgical site infections. In this study, a broad definition of infection allowed for a more inclusive look at post-operative complications.
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