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Predictors of Successful Outcomes Following Revision Carpal Tunnel Release
Akhil Dondapati, MD
1; Thomas J Carroll, MD
1; Warren C. Hammert, MD
2; Bilal Mahmood, MD
31University of Rochester Medical Center, Rochester, NY; 2Duke University, Durham, NC; 3University of Rochester, Rochester, NY
Purpose: We sought to identify predictors of successful revision carpal tunnel release (CTR) and compare long-term patient-reported outcomes to individuals who underwent primary CTR. We hypothesized that patients undergoing revision CTR would have worse patient-reported outcomes scores at 1-year follow-up.
Methods: We retrospectively compared 521 primary CTR and 57 revision CTR patients. Patients with minimum one-year follow-up, including PROMIS and Patient Acceptable Symptom State (PASS) scores, were included. PASS and PROMIS Upper Extremity (UE), Pain Interference (PI), and Physical Function (PF) were compared at pre-operative and 1-year post-operative timepoints. Demographic and surgical data were compared using univariate and multivariable analysis.
Results: Compared to the primary CTR group, the revision group had a higher BMI, was more likely to be male, be affected on their dominant hand, have diabetes, undergo endoscopic CTR, and have concurrent cubital tunnel syndrome (CuTS). A chief complaint of pain (OR 0.23), tobacco use (OR 0.11), or diabetes (OR 0.22) were less likely to have a positive PASS response, while having an interval steroid injection (OR 6.2) was a predictor of a positive PASS response. PROMIS UE and PI were better in the primary group at both pre-op and 1-year post-op visits. PROMIS PF was improved in the primary group at 1-year. All PROMIS modalities did not significantly improve at 1-year follow-up in the revision group compared to pre-op. However, final PROMIS scores were improved in the primary CTR group compared to revision group in all categories. Positive PASS response in the revision group was significantly lower pre-operatively and 1-year post-operatively.
Conclusions: Steroid injections, lack of diabetes and tobacco use, and chief complaint of paresthesias or weakness, rather than pain, are predictors of satisfactory outcomes after revision CTR. Patients undergoing revision demonstrated worse PROMIS scores than primary CTR at 1-year follow-up.
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