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The Impact of Bariatric Surgery on Carpal Tunnel Syndrome: Outcomes and Management Strategies
Vennela Challagondla, BS, MPH
1; Brett Drake, B.S.
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: This study aimed to evaluate and compare the incidence of carpal tunnel syndrome (CTS) and postoperative outcomes after carpal tunnel surgery in patients with and without a history of bariatric surgery.
METHODS: Utilizing the PearlDiver Mariner database, which includes data on over 165 million patients from 2010 to 2022, we identified individuals diagnosed with CTS and those who underwent carpal tunnel surgery using ICD-9, ICD-10, and CPT codes. Patients were divided into two groups: those with prior bariatric surgery and those without, matched 1:10 by age, sex, and Charlson Comorbidity Index. We compared demographics, comorbidities, and postoperative outcomes—nerve injury, complex regional pain syndrome (CRPS), additional carpal tunnel surgeries, and emergency department (ED) visits—using Chi-square and Student's t-tests. A Kaplan-Meier curve was used to illustrate the time from initial carpal tunnel surgery to subsequent surgeries.
RESULTS: The study included 26,309 patients with prior bariatric surgery and CTS, compared to 263,069 patients without prior bariatric surgery. Significant differences were found between the groups. Patients with prior bariatric surgery had higher rates of comorbidities, including anemia, depression, diabetes, electrolyte disorders, hypertension, hypothyroidism, autoimmune diseases, cervical radiculopathy, vitamin B12 deficiency, and peripheral neuropathy (all p<0.001). These patients were also more likely to undergo carpal tunnel surgery (25.90% vs. 18.44%, p<0.001), cubital tunnel surgery (4.38% vs. 2.79%, p<0.001), and visit the ED (83.36% vs. 76.21%, p<0.001) compared to those without prior bariatric surgery. Postoperative data from 5,918 patients with prior bariatric surgery and 59,140 without showed similar trends in comorbidities. Rates of postoperative nerve injury and CRPS were not significantly different between groups. However, patients with a history of bariatric surgery were significantly more likely to require additional carpal tunnel surgery within 2 years of the initial operation.
CONCLUSION: This study underscores that patients with a history of bariatric surgery and CTS have more comorbidities, a higher likelihood of undergoing carpal and cubital tunnel surgeries, and worse postoperative outcomes. Nutritional deficiencies and metabolic changes post-bariatric surgery may exacerbate neuropathy, leading to increased surgical intervention. The higher prevalence of cervical radiculopathy and peripheral neuropathy suggests a possible double crush syndrome, highlighting the necessity for tailored preoperative and postoperative care strategies for this patient population.
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