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Impact of Chronic Kidney Disease on Outcomes Following Open Versus Endoscopic Carpal Tunnel Release: A Retrospective Cohort Study
Joshua Wang, MS
1, Philong Nguyen, BS
1, Carolyn Henein, MS
1, Cameron Bowers, BS
1, Yousef Tanas, M.D.
2; John Faillace, MD
1(1)University of Texas Medical Branch, Galveston, TX, (2)Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
Introduction:
Chronic kidney disease (CKD) is associated with systemic inflammation and impaired wound healing, which may influence surgical outcomes. However, the impact of CKD on complication rates following open versus endoscopic carpal tunnel release remains unclear. This retrospective cohort study evaluates the effect of CKD on postoperative outcomes in patients undergoing carpal tunnel surgery using either open or endoscopic techniques.
Methods:
The TriNetX Research database was queried for adult patients with a preexisting diagnosis of CKD who underwent either open or endoscopic carpal tunnel release between January 1, 2000, and April 4, 2023. Patients were matched using propensity score matching based on demographics, body mass index, comorbidities (diabetes, hypertension), rheumatoid arthritis, substance use (tobacco). Outcomes included postoperative wound dehiscence, surgical site infection, sepsis, hospital readmission, revision surgery, and new-onset trigger finger. Risk ratios were calculated at 3-, 12-, and 24-months post-procedure. Statistical significance was set at p < 0.05.
Results:
At 90 days, endoscopic carpal tunnel release was associated with significantly lower rates of surgical site infection (RR: 0.476, p = 0.047), sepsis (RR: 0.400, p = 0.011), and hospital readmission (RR: 0.646, p = 0.005), but a significantly higher rate of revision surgery (RR: 1.259, p = 0.016). Differences in wound dehiscence (RR: 0.556, p = 0.129) and trigger finger (RR: 1.533, p = 0.178) were not statistically significant.
At 1 year, endoscopic release continued to show reduced rates of infection (RR: 0.462, p = 0.005), sepsis (RR: 0.573, p = 0.003), and readmission (RR: 0.541, p < 0.001), with no significant differences in wound dehiscence (RR: 0.762, p = 0.408), revision surgery (RR: 1.130, p = 0.111), or trigger finger (RR: 1.298, p = 0.103).
At 2 years, readmission remained significantly lower with endoscopic release (RR: 0.734, p = 0.013), while trigger finger incidence became significantly higher (RR: 1.359, p = 0.022). No significant differences were observed in wound dehiscence (RR: 0.690, p = 0.119), infection (RR: 0.643, p = 0.068), sepsis (RR: 0.845, p = 0.248), or revision (RR: 1.047, p = 0.507).
Conclusion:
Endoscopic carpal tunnel release is associated with lower short-term rates of infection, sepsis, and readmission compared to the open approach, but carries a higher early revision risk and increased long-term incidence of trigger finger. These findings highlight important trade-offs that should inform surgical decision-making.
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