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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Risk Factors for Revision Carpal Tunnel Release
Catherine A de Planque, BSc1; Kamilcan Oflazoglu, MD1; Gina M Poerio, PA1; Kyle R Eberlin, MD2; Jesse B Jupiter, MD3; Neal C Chen, MD4; (1)Massachusetts General Hospital, Boston, MA, (2)Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts General Hospital/Harvard Medical School, Boston, MA, (3)Orthopaedice Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, (4)Massachusetts General Hospital/Harvard Medical School, Boston, MA

Introduction: There is no consensus in literature about the risk factors developing a recurrent carpal tunnel syndrome after carpal tunnel release (CTR). The first aim of this study was to determine the rate of revision carpal tunnel release in two urban hospitals in a period of 14 years. The secondary aim was to assess whether demographic, condition-related and treatment related factors are associated with revision carpal tunnel release.

Materials & Methods: 8118 patients underwent CTR between 2002 and 2015. After manually reviewing the medical record, we identified 114 patients who underwent revision surgery. Multivariable logistic regression analysis was done to study association with demographics (age, sex, and race), unilateral or bilateral treated wrist(s) (including CTR performed simultaneously and separately), and type of surgery (open or endoscopic).
To gain further insight into these factors, those 114 patients (case groups) were randomly matched with a control group (CTR patient without revision surgery) on age, race, sex, bilateral or unilateral treated wrist(s), and type of surgery (open or endoscopic). Multivariable conditional logistic regression for paired data was done to identify factors independently different in the case-control.

Results: 1.4% (114 of 8118) of the patients underwent revision carpal tunnel surgery. The mean time to revision surgery was 2.6 years (SD 2.8). In multivariable logistic regression analysis, older age (OR, 1.0; 95% CI, 1.0- 1.0; SE, 0.0070; p=0.003), bilateral CTR (OR, 13; 95% CI, 8.2-21; SE 3.1; p<0.001), and endoscopic CTR (OR, 2.3; 95% CI, 1.3-4.4; SE 0.74; p = 0.008) were independently associated with higher odds for revision surgery.
Patients who underwent a revision CTR were treated less often with a splint prior to initial surgery compared to the matched control group, 51% vs. 75% respectively (p<.001). However, in the multivariable conditional logistic regression, preoperative splint therapy was not independently different in both groups (p=0.11) when occupation (laborer vs. non-laborer) and EMG severity were included.

Conclusions: Endoscopic release and bilateral treated hands are risk factors for revision surgery.


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