Carpal tunnel decompression surgery rarely results in serious complications or reoperations, a U.K. study suggests. Researchers examined data on 855,832 carpal tunnel decompression surgeries done for adults with National Health Service coverage between 1998 and 2017. Overall, just 620 surgeries (0.07%) led to serious complications such as surgical site infection or dehiscence, or neurovascular or tendon injury leading to readmission or reoperation within 30 days. Within 90 days, this rose to 698 procedures (0.082%) with serious complications. A total of 29,288 surgeries led to reoperation (incidence rate 3.18 per 1,000 person-years). "This study captures all the carpal tunnel surgeries that were paid for within all NHS hospitals over a 19 year period, which means that the results here are generalizable to all patients that present within a nationalized healthcare service," said lead study author Jennifer Lane of the University of Oxford in the U.K. "Since we had such a broad inclusion criteria, and since many carpal tunnel surgeries are undertaken in England each year, we don't believe the low rates of serious complications are due to patient selection, but that the procedure is safe compared to other interventions," Lane said by email. The 90-day complication rates were higher for male patients (adjusted subhazard ratio 2.32), and for patients ages 18-29, compared to older individuals (aSR 2.25). The most common serious postoperative complications were wound dehiscence (0.030% and 0.033% at 30 and 90 days, respectively); tendon injury (0.028% and 0.033% at 30 and 90 days, respectively); neurovascular injury (0.010% at 30 and 90 days); and wound infection (0.0037% and 0.0050% at 30 and 90 days, respectively). Men also had higher risk for reoperation (aSR 1.09), as did patients over age 80 compared to patients ages 50-59 (aSR 1.09). More comorbidities were also tied to higher reoperation risk (aSR 1.25 for Charleston score of 5 or more vs Charleston score of 0). Minor complications including wound infections treated in primary care were not tracked, and might contribute to an underestimation of infection rates and local complication rates. Another drawback is that the administrative NHS data used for the analysis might not track certain complications like regional pain syndrome or scar tenderness, the study team notes in The Lancet Rheumatology. Even so, the findings can be used to inform patient decisions about surgery and to inform national health policy, the study team writes. —Lisa Rapaport Source
