Ozdag Yagiz, Koshinski Jessica L, Hayes Daniel S, Cornwell David, Garcia Victoria C, Klena Joel C, Grandizio Louis C
Department of Orthopaedic Surgery, Geisinger Health System, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
Biostatistics Core, Geisinger Health System, Henry Hood Research Center, Danville, PA.
J Hand Surg Am. 2025 Jan;50(1):60-69. doi: 10.1016/j.jhsa.2024.09.018. Epub 2024 Nov 16.
To compare rates of revision surgery between primary endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). In addition, we aimed to assess the influence of fellowship training on revision rates. We hypothesized that ECTR would not be associated with higher rates of revision surgery.
We conducted a retrospective, single-center replication study of a recently published comparative assessment of ECTR and OCTR. All patients between 18 and 75 years old undergoing primary ECTR or OCTR over a 6-year period were included if they were seen within 1 year after surgery. To control for confounding, adjusted binary logistic regression models were inverse-weighted by propensity scores. Early (12 months) and overall revision rates were compared between ECTR and OCTR, as were revision rates relative to surgeon training.
A total of 4,160 patients and 63 surgeons were included. Eighty-one percent underwent OCTR. Nine patients (0.21%) underwent revision within 12 months of index CTR at a mean of 231 days postoperatively. The early revision rate for OCTR and ECTR were 0.24% and 0.13%, respectively. After adjusting for patent characteristics and confounding, ECTR cases were 0.28 times (95% confidence interval, 0.09-0.90) less likely to undergo revision. Early OCTR revision rates for hand surgeons were similar to nonhand surgeons (0.23% vs 0.24%); however, statistically significant higher revision rates were noted for nonhand surgeons (1.04%) compared to hand surgeons (0.42%) for revisions beyond 12 months.
Within a single health care system, the early revision rate after primary CTR was 0.21%. When adjusting for patient characteristics and controlling for confounding, ECTR was 0.28 times less likely to undergo revision compared to OCTR. Hand fellowship training was associated with lower OCTR revision rates beyond 1 year. These data highlight the need for future investigations to clearly define indications for, and outcomes following, revision CTR.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
比较初次内镜下腕管松解术（ECTR）和开放性腕管松解术（OCTR）的翻修手术率。此外，我们旨在评估专科培训对翻修率的影响。我们假设ECTR与较高的翻修手术率无关。
我们对最近发表的一项关于ECTR和OCTR的比较评估进行了回顾性单中心重复研究。纳入所有年龄在18至75岁之间、在6年期间接受初次ECTR或OCTR且术后1年内接受随访的患者。为控制混杂因素，采用倾向评分进行反向加权调整二元逻辑回归模型。比较ECTR和OCTR的早期（12个月）和总体翻修率，以及与外科医生培训相关的翻修率。
共纳入4160例患者和63名外科医生。81%的患者接受了OCTR。9例患者（0.21%）在初次腕管松解术后12个月内接受了翻修，平均术后231天。OCTR和ECTR的早期翻修率分别为0.24%和0.13%。在调整患者特征和混杂因素后，ECTR病例接受翻修的可能性降低0.28倍（95%置信区间，0.09 - 0.90）。手外科医生的早期OCTR翻修率与非手外科医生相似（0.23%对0.24%）；然而，在术后12个月以上的翻修中，非手外科医生的翻修率（1.04%）显著高于手外科医生（0.42%）。
在单一医疗系统中，初次腕管松解术后的早期翻修率为0.21%。在调整患者特征并控制混杂因素后，ECTR接受翻修的可能性比OCTR低0.28倍。专科培训与术后1年以上较低的OCTR翻修率相关。这些数据凸显了未来研究明确翻修腕管松解术的适应证和术后结果的必要性。
研究类型/证据水平：预后II级
