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The Effect of Bariatric Surgery on Surgical Outcomes and Care Strategies for Cubital Tunnel Syndrome
Brett Drake, B.S.
1; Vennela Challagondla, BS, MPH
1; Nirav K Mungalpara, M.D.
1; Apurva Choubey, M.D.
1; Mark Gonzalez, MD, PhD
21University of Illinois at Chicago, Chicago, IL; 2University of Illinois at Chicago, Department of Orthopaedic Surgery, Chicago, IL
OBJECTIVE: Research on the effects of prior bariatric surgery on outcomes following cubital tunnel surgery is limited. This study evaluates and compares factors influencing the development of cubital tunnel syndrome (CuTS) and postoperative outcomes following cubital tunnel surgery in patients with and without a history of bariatric surgery.
METHODS: Using the PearlDiver Mariner database, which includes records from 165 million patients from 2010 to 2022, we identified patients with CuTS and those undergoing cubital tunnel surgery via ICD and CPT codes. Patients were divided into cohorts based on bariatric surgery history, matched 1:10 with controls by age, sex, and Charlson Comorbidity Index. Demographics, comorbidities, and outcomes—nerve injury, complex regional pain syndrome (CRPS), additional tunnel surgeries, and emergency department (ED) visits—were compared using Chi-square tests. A Kaplan-Meier curve assessed the time from initial cubital tunnel surgery to subsequent procedures.
RESULTS: The study included 6,044 patients with prior bariatric surgery and 60,418 without, all diagnosed with CuTS. Patients with a history of bariatric surgery had significantly higher rates of comorbidities compared to those without, including anemia (36.04% vs. 19.98%, p<0.001), depression (70.87% vs. 61.67%, p<0.001), and diabetes (66.14% vs. 47.14%, p<0.001). Additionally, these patients had higher rates of ED visits (85.44% vs. 81.65%, p<0.001) and subsequent carpal tunnel surgeries (61.79% vs. 56.29%, p<0.001). Among those who underwent cubital tunnel surgery (1,332 with prior bariatric surgery and 13,291 without), similar trends were observed, with higher comorbidity rates and a tendency towards more subsequent cubital tunnel surgeries within 2 years among bariatric surgery patients (p=0.062). Patients with a history of bariatric surgery were more likely to require an additional cubital tunnel surgery within 2 years of the initial operation compared to those without bariatric surgery.
CONCLUSIONS: Patients with CuTS who have undergone bariatric surgery exhibit more comorbidities and are more likely to undergo additional carpal and cubital tunnel surgeries, suggesting worse neuropathy symptoms. The higher prevalence of cervical radiculopathy and peripheral neuropathy in these patients indicates a possible double crush syndrome. Further research is needed to explore the impact of nutritional interventions post-bariatric surgery on the progression of cubital tunnel syndrome and to develop tailored care strategies for this patient population.
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