Reoperation Rates and Short-Term Complications Following Endoscopic vs. Open Carpal Tunnel Release: A Longitudinal Analysis.

Background: Carpal tunnel syndrome (CTS), affecting approximately 8% of the population, is treated with open (oCTR) or endoscopic (eCTR) carpal tunnel release. Previous literature compares outcomes within 1 to 2 years; this study evaluated >5-year reoperation rates and short-term complications using a large electronic health record database.

Methods: A retrospective analysis using data from the TriNetX Research Network (2007-2024) identified patients with unilateral CTS who underwent either oCTR or eCTR within 1 year of diagnosis, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Propensity score matching and multiple logistic regression calculated adjusted risk and odds ratios (ORs) with 95% confidence intervals (95% CIs) to assess reoperation rates at 2, between 2 and 5, >5 years after operation and 90-day postoperative complications (wound dehiscence, surgical site infection [SSI]).

Results: Within 2 years of CTR, reoperation rate was higher for eCTR than that for oCTR (relative risk [RR] = 1.15, 95% CI = 1.09-1.22; OR = 1.36, 95% CI = 1.21-1.53). Beyond 5 years, the revision rate of the two approaches was similar (RR = 0.85, 95% CI = 0.74-1.01; OR = 0.76, 95% CI = 0.58-1.00). The number needed to treat to prevent one reoperation within 2 years was 67, and beyond 5 years, it was 473. Within 90 days of surgery, eCTR was associated with decreased wound dehiscence (RR = 0.67, 95% CI = 0.53-0.85; OR = 0.50, 95% CI = 0.36-0.71) and SSI (RR = 0.77, 95% CI = 0.65-0.91; OR = 0.63, 95% CI = 0.48-0.81).

Conclusion: This study demonstrates the clinical insignificance of the difference in early CTR revision rate between approaches and that eCTR necessitates a similar reoperation rate at long term, supporting eCTR to remain an appropriate intervention for CTR.