Effects of autoimmune rheumatic disease on carpal tunnel release outcomes: A single-institution propensity-matched analysis.

Abstract

Few studies have investigated outcomes of carpal tunnel release (CTR) in patients with rheumatic disease. We hypothesized that this population may benefit from operative intervention despite postoperative complication and revision risk. A retrospective study evaluated CTR outcomes in patients with and without rheumatic disease at the Cleveland Clinic. Demographics, exam, electromyography, and DASH scores were collected. Primary outcome was postoperative complication rate. Secondary outcomes were revision CTR and improvement in DASH scores. Propensity score matching was used to assemble cohorts with similar baseline characteristics. After propensity score matching, 896 patients were included with 448 patients in each cohort. Complication rates in the rheumatic cohort (n = 50, 11.2%) were significantly higher than those in the non-rheumatic cohort (n = 13, 2.9%) (p < 0.001; RR, 3.85); the complications included surgical site infection (n = 17, 3.8% versus n = 6, 1.3%; p = 0.02; RR, 2.83), prolonged edema (n = 9, 2% versus n = 1, 0.2%; p = 0.01; RR, 9), and revision CTR (n = 21, 4.7% versus n = 8, 1.8%, p = 0.007). Wound dehiscence was not significantly different (n = 11, 2.5% versus n = 6, 1.3%; p = 0.20; RR, 1.83). Patients with rheumatic disease reported significant improvement in DASH scores comparable with patients without rheumatic disease (30.5 versus 25.3, p = 0.11). The patients with rheumatic disease and normal individuals experienced significant improvement in subjective disability after CTR, but they should be informed of the risks of minor postoperative complication and revision surgery.