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Endoscopic Versus Open Treatment of Carpal Tunnel Syndrome: Postoperative Complications in Patients Receiving Anticoagulation Therapy
Arman Kishan, MBBS
1; Sami H. Tuffaha, MD
2; Dawn M Laporte, MD
1; Duc M Nguyen, MD
31Johns Hopkins University, Baltimore, MD; 2Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 3Johns Hopkins Medicine, Columbia, MD
Introduction Patients receiving anticoagulation therapy can be at increased risk for certain postoperative complications. Few studies have investigated the complication rates of patients undergoing carpal tunnel release (CTR) while on anticoagulation. Our objective was to examine and compare the occurrence of complications in patients on anticoagulation therapy who underwent endoscopic CTR (ECTR) or open CTR (OCTR) for carpal tunnel syndrome (CTS).
Methods The TriNetX database was utilized to retrospectively identify patients who underwent OCTR or ECTR while on anticoagulation. Demographic data, medical comorbidities, and complication rates were analyzed. We used multivariable analysis to identify the following differences in postoperative complications in patients on anticoagulation: wound infection within 90 days, wound dehiscence within 90 days, and intraoperative median nerve injury between the two surgical methods.
Results Included in the study were 12,341 CTS patients on anticoagulation therapy (OCTR, 10307; ECTR, 2034). Among patients on anticoagulation, those who underwent ECTR exhibited a significantly lower occurrence of 90-day wound infection, nerve injury, venous thromboembolism, and pulmonary embolism
than those who underwent OCTR. However, there was no significant difference in the risk of 90-day wound dehiscence between the two groups.Conclusions: Our study demonstrated that, among patients on anticoagulation, those undergoing ECTR experienced a significantly lower incidence of 90-day wound infection and nerve injury. These findings suggest that patients on anticoagulation therapy may benefit from undergoing ECTR rather than OCTR.
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