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Comparative Outcomes of Endoscopic versus Open Carpal Tunnel Release in Postmenopausal Women: A Retrospective Cohort Analysis of 16,298 Patients
Matthew Q. Dao, BS
1, Emma M. Lascar, BS
2, Sahil Sharma, BS
3, Rebecca Suydam, MD
4, Alex Sarosi, MD
4; BaiJing Qin, MD
5(1)John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, (2)School of Medicine, University of Washington, Seattle, WA, (3)Georgetown University School of Medicine, Washington, DC, (4)Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, (5)Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX
Introduction: Women have a nearly threefold increased risk of developing carpal tunnel syndrome (CTS) compared to men, with incidence rising sharply between ages 45 and 54. However, comparative outcomes of open (oCTR) versus endoscopic carpal tunnel release (eCTR) in this population is limited. This study evaluates short- and long-term complications of oCTR versus eCTR in postmenopausal women.
Materials and Methods: A retrospective review was conducted using the TriNetX US Collaborative Network. Postmenopausal female patients aged ?45 years who underwent either oCTR or eCTR were identified between 2015 and 2025. Cohorts were 1:1 propensity score matched by demographics, body mass index, hemoglobin A1c, and comorbidities. Primary outcomes included 90-day complications: wound disruption, surgical site infection, wrist stiffness, and physical therapy evaluations. The secondary outcome was CTS recurrence within 1 year. Outcomes were compared using multiple univariate analysis, with absolute risk percentages and risk ratios calculated. Significance was defined as p < 0.05.
Results: A total of 16,298 postmenopausal women were included after propensity score matching (8,149 per group). Compared to the eCTR group, patients who underwent oCTR had significantly higher rates of wound disruption (0.4% vs 0.2%, p = 0.020), surgical site infection (0.6% vs 0.3%, p = 0.002), wrist stiffness (1.2% vs 0.5%, p < 0.001), and needed more physical therapy (4.3% vs 3.1%, p = 0.002) within 90 days of surgery. However, at 1-year follow-up, the rate of CTS recurrence was significantly more frequent in the eCTR group (12.7% vs 43.8%, p < 0.001).
Conclusions: Among postmenopausal women, eCTR is associated with fewer postoperative complications in the short term but a higher risk recurrence at one year compared to oCTR. The present study provides evidence-based guidance for optimizing surgical planning in this demographic population. Surgeons are therefore encouraged to weigh the benefits of quicker recovery with eCTR against the superior long-term durability of oCTR when counseling patients on the most appropriate operative treatment.
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