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Endoscopic versus Open Carpal Tunnel Release in Patients with Rheumatoid Arthritis: An Outcomes Comparison
Kevin G Hu, BA
1; Alexander J Kammien, BS
1; David L Colen, MD
21Yale School of Medicine, New Haven, CT; 2Yale University School of Medicine, New Haven, CT
IntroductionThis study evaluates whether carpal tunnel release (CTR) outcomes are comparable between open and endoscopic techniques in patients with rheumatoid arthritis (RA), specifically with respect to reoperation rates and postoperative analgesia.
Materials and MethodsInclusion criteria were a diagnosis of either seropositive or seronegative RA (ICD: M05, M06) and carpal tunnel syndrome (ICD: G65), as well as a minimum of 1 year of follow-up. Patients receiving concurrent trigger finger release (CPT: 26055, 26145) or distal radius fracture fixation (CPT: 25607, 25608, 25609) were excluded. Patients were identified as having received either endoscopic CTR (CPT: 29848) or open CTR (CPT: 64721). Patients were categorized by the type of RA treatment: glucocorticoids, non-biologic disease-modifying anti-rheumatic drug (DMARDs), and biologic DMARDs. Patients were matched by age, sex, and ECI score. Multivariable linear and logistic regression were used to compare reoperation rates, opioid prescription fill rates, and opioid prescription millimorphine equivalents (MME) across the two techniques.
ResultsAfter matching, 6127 patients met inclusion criteria in each of the endoscopic CTR and open CTR cohorts. Patients were on average 61 ± 12 years of age, 75.0% female (n = 4599), and had an average ECI score of 5.7 ± 3.6 in both cohorts. The average length of follow-up was 4.2 ± 2.7 years across all patients. Significant differences between the cohorts existed with respect to patient region (p<0.001), insurance (p<0.001), and smoking status (p=0.002), but not RA treatment or diabetes mellitus.
Controlling for patient demographics, comorbidities, and RA treatment, patients receiving endoscopic CTR were not significantly more likely to receive reoperation (OR = 0.95, 95% Confidence Interval: 0.76-1.97). Patients receiving any treatment for RA were significantly more likely to receive reoperation (OR = 7.08, 95CI: 5.62-8.92).
Endoscopic CTR was associated with decreased odds of filling opioid prescriptions (OR = 0.92, 95CI: 0.85-0.99) and no significant difference in the quantity of opioids prescribed (b = -31.1 MME, 95CI: -80.1-17.9). On the other hand, any RA treatment was associated with greater odds of filling opioids prescriptions (OR = 1.85, 95CI: 1.11-1.31) and an increased quantity of opioids prescribed (b = 94.7 MME, 95CI: 32.6-156.8).
ConclusionsIn RA patients, endoscopic CTR does not lead to higher reoperation rates than open CTR. Postoperative analgesia was also similar between the two techniques. Thus, RA should not be considered a contraindication for endoscopic CTR, although RA treatments should be considered when counseling patients.
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