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Early Outcomes of Endoscopic Versus Open Carpal Tunnel Release.

MedStar author(s):

Citation: Journal of Hand Surgery - American Volume. 46(10):868-876, 2021 10.PMID: 34049728Institution: Curtis National Hand Center | MedStar Union Memorial HospitalDepartment: Orthopaedic Surgery ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Carpal Tunnel Syndrome | Adolescent | Adult | Carpal Tunnel Syndrome/su [Surgery] | Endoscopy | Female | Humans | Middle Aged | Neurosurgical Procedures | Patient Reported Outcome Measures | Postoperative PeriodYear: 2021 Local holdings: Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - presentISSN:

0363-5023

Name of journal: The Journal of hand surgeryAbstract: CONCLUSIONS: This study found no evidence suggesting the definitive superiority of 1 surgical technique with regard to clinical outcomes in the early postoperative period. However, OCTR was associated with lower postoperative PROMIS upper-extremity scores of unclear clinical significance, higher odds of remaining on pain medication, and lower odds of returning to work by the first postoperative visit. Endoscopic carpal tunnel release may be preferred in patients who need to return to work within the first 2 weeks after the procedure.METHODS: We included all patients over 18 years of age undergoing carpal tunnel release at a single hand center between January 2018 and December 2019. The carpal tunnel release method was driven by variations in surgeon practice. Data from patient-reported outcomes measurement information system (PROMIS) questionnaires and brief Michigan hand outcomes questionnaires and data on patient-reported pain levels, satisfaction with care, return to work, and postoperative prescription pain medication use were collected at preoperative visits and the first follow-up visit between postoperative days 7 and 14.PURPOSE: To compare the short-term outcomes of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR), including patient-reported outcomes, pain and satisfaction scores, return to work, and postoperative prescription pain medication use.RESULTS: We included 678 (586 ECTR and 92 OCTR) patients. The median age was 58 years, and 75% of the patients were women. At early follow up, patients who underwent OCTR reported significantly lower postoperative PROMIS upper-extremity scores than those who underwent ECTR (median, 32 vs 36 points, respectively) but similar postoperative PROMIS pain interference, global physical health, global mental health, and brief Michigan hand outcomes questionnaire scores. The postoperative pain and satisfaction scores were similar between the 2 groups. In multivariable models, patients who underwent OCTR had 62% lower odds of returning to work and 30% greater odds of remaining on a postoperative pain prescription at the first follow-up visit.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. Copyright (c) 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.All authors: Bhayana K, Giladi AM, Miles MR, Sanghavi KK, Shetty PN, Yousaf ISOriginally published: Journal of Hand Surgery - American Volume. 2021 May 25Fiscal year: FY2022 Fiscal year of original publication: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.jhsa.2021.04.030

Date added to catalog: 2021-06-28

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34049728	Available		34049728

Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present

CONCLUSIONS: This study found no evidence suggesting the definitive superiority of 1 surgical technique with regard to clinical outcomes in the early postoperative period. However, OCTR was associated with lower postoperative PROMIS upper-extremity scores of unclear clinical significance, higher odds of remaining on pain medication, and lower odds of returning to work by the first postoperative visit. Endoscopic carpal tunnel release may be preferred in patients who need to return to work within the first 2 weeks after the procedure.

METHODS: We included all patients over 18 years of age undergoing carpal tunnel release at a single hand center between January 2018 and December 2019. The carpal tunnel release method was driven by variations in surgeon practice. Data from patient-reported outcomes measurement information system (PROMIS) questionnaires and brief Michigan hand outcomes questionnaires and data on patient-reported pain levels, satisfaction with care, return to work, and postoperative prescription pain medication use were collected at preoperative visits and the first follow-up visit between postoperative days 7 and 14.

PURPOSE: To compare the short-term outcomes of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR), including patient-reported outcomes, pain and satisfaction scores, return to work, and postoperative prescription pain medication use.

RESULTS: We included 678 (586 ECTR and 92 OCTR) patients. The median age was 58 years, and 75% of the patients were women. At early follow up, patients who underwent OCTR reported significantly lower postoperative PROMIS upper-extremity scores than those who underwent ECTR (median, 32 vs 36 points, respectively) but similar postoperative PROMIS pain interference, global physical health, global mental health, and brief Michigan hand outcomes questionnaire scores. The postoperative pain and satisfaction scores were similar between the 2 groups. In multivariable models, patients who underwent OCTR had 62% lower odds of returning to work and 30% greater odds of remaining on a postoperative pain prescription at the first follow-up visit.

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