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Improved Outcomes with Endoscopic Carpal Tunnel Release for Patients who Smoke
Jeffrey Coombs, MD
1, Christopher M Dussik, MD
1, Amy Phan, MD
1, Joseph Ferraro, MD
2, Danielle M Wilbur, MD
1; Constantinos Ketonis, MD, PhD
1(1)University of Rochester Medical Center, Rochester, NY, (2)University of Rochester, Rochester, NY
Purpose: While both endoscopic and open carpal tunnel release are effective treatments for carpal tunnel syndrome, with prior studies suggesting similar long-term outcomes, data on perioperative complication rates in high-risk populations, such as smokers, remain limited. Given the potential for impaired wound healing and increased infection risk in smokers, a better understanding of complication profiles between techniques in this subgroup is warranted. This study aimed to compare the perioperative complication rates of endoscopic vs open carpal tunnel release in patients who smoke.
Methods: We conducted a retrospective cohort study using the TriNetX database, identifying 22,435 open and 4,947 endoscopic carpal tunnel release procedures performed in patients who smoke. We assessed 90-day postoperative complication rates in both cohorts, including hospital admissions, emergency department (ED) visits, infections, nerve injuries, renal injuries, and thrombotic events. Propensity score matching was performed to reduce confounding and ensure comparability between groups.
Results: Rates of median nerve injury, postoperative admissions, ED visits, superficial infections, and acute kidney injury (AKI) were significantly higher in patients undergoing open carpal tunnel release compared to those undergoing endoscopic carpal tunnel release, with odds ratios ranging from 1.3 to 3.4. After adjusting for demographic and comorbidity variables, increased odds of median nerve injury, postoperative admissions, ED visits, and superficial surgical site infections (SSIs) remained significant.
Conclusions: Among patients who smoke, those undergoing open carpal tunnel release experienced higher 90-day perioperative complication rates compared to those treated with endoscopic release. This difference remained significant in both unmatched and propensity score-matched analyses, suggesting that endoscopic techniques may offer improved short-term outcomes for patients with nicotine dependence.
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