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Characterizing Increased Risk of Heart Failure Following Carpal Tunnel Release Surgery
Harrison S Fellheimer, BA
1; Mahaa Ayub, BA
1; Gabriel I Onor, MD
2; Lauren O'Mara, MD
2; Eric Tecce, MD
2; Pedro K Beredjiklian, MD
31Thomas Jefferson University, Philadelphia, PA; 2Thomas Jefferson University Hospital, Philadelphia, PA; 3Rothman Orthopaedic Institute, Philadelphia, PA
Introduction: Previous literature has detailed a potential relationship between carpal tunnel syndrome (CTS) and heart failure (HF), indicating that patients with CTS are more likely than the general population to have cardiomyopathy during their lifetime. Amyloid deposition leading to CTS may be prodromal for the development of amyloid cardiomyopathy. We hypothesized that patients undergoing surgery would have an increased risk of HF compared to patients with CTS who did not undergo surgery.
Methods:The TriNetX database was retrospectively queried on June 24th, 2024. The patient population was identified using the primary ICD-10 code for CTS. Patient were included if they had surgical treatment for CTS reported as endoscopic carpal tunnel release, open carpal tunnel release, or median nerve release. The primary outcome of the analysis was heart failure. Propensity scoring was used to mediate age and gender effects. Ultimately, 125,304 patients were analyzed in the study with 62,652 patients in both the operative and nonoperative groups. statistical analyses were performed through TriNetX and p-values were used to determine statistical significance. Statistical significance was set at p < 0.05, and odds ratios were calculated at 95% confidence intervals (CI).
Results:The incidence of HF in patients who underwent CTR 3.30%, 5.50%, 6.20%, and 6.30% at five, ten, fifteen, and twenty years postoperatively, respectively. When compared to nonsurgical patients, the risk difference of 0.6 (95% CI: 0.3, 0.8) became statistically significant at ten years (p < 0.001) with an increased risk ratio (RR) of 1.119 (95% CI: 1.067, 1.175) for surgical patients. At fifteen years, the risk difference was 0.7% (95% CI: 0.4, 1.10) with an RR of 1.127 (1.077, 1.179). The risk difference peaked at 0.9 (95% CI: 0.6, 1.2) at the twenty-year mark with an RR of 1.168 (95% CI: 1.116, 1.222).
Conclusion:This study demonstrates that at ten, fifteen, and twenty-year time points, patients who underwent CTR were more likely to have progressed to heart failure and other cardiac complications than propensity score-matched controls managed nonoperatively. In CTS patients at higher risk for cardiac amyloidosis, hand surgeons can play a critical role in early diagnosis by performing tissue biopsy during CTR, helping to decrease the incidence of adverse cardiac outcomes.
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