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Early Revision Rate Following Primary Carpal Tunnel Release
Jack Graham, MD1; Kyle J Plusch, BA2; Bryan Hozack, MD3; Asif M Ilyas, MD, MBA2; Jonas Matzon, MD4
1Rothman Institute, philadelphia, PA; 2Rothman Institute at Thomas Jefferson University, Philadelphia, PA; 3Rothman Institute, Philadelphia, PA; 4Rothman Institute, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA

Introduction: The revision rate after carpal tunnel release (CTR) is poorly understood, with currently published rates in the literature ranging widely from 0.3 to 7%. The purpose of this study was to determine the rate of revision CTR following primary CTR at a single, large, multi-center practice. It was hypothesized that the rate of revision CTR would be lower than recently reported rates.
Materials & Methods: We identified all patients who underwent primary CTR at a single orthopaedic practice by 18 fellowship-trained orthopaedic hand surgeons from 10/1/2015 through 10/1/2020, using a combination of CPT and ICD-10 codes. Patients who underwent CTR due to a diagnosis other than primary CTS were excluded. Following stringent database review, operative and outpatient clinic notes were reviewed in all patients requiring revision CTR to determine the cause for revision. Patient demographics, surgical technique (open vs. endoscopic), and a history of co-morbidities associated with higher risk for CTS were collected. Multivariate logistic regression was planned to determine potential associations of risk factors with revision.
Results: A total of 11,847 primary CTR procedures were performed during the five-year period on 9,310 patients. The overall cohort consisted of 79.5% open CTR and 20.5% endoscopic CTR. We found 24 revision CTR procedures among 23 patients, resulting in a revision rate of 0.2%. Of the 9,422 open primary CTRs performed, 0.23% (22 cases) went on to revision. Endoscopic CTR was performed in 2,425 cases with 0.08% (2 cases) ultimately being revised. The average length of time from primary CTR to revision was 436 days (range 11-1647). The small size of the revision cohort precluded the use of multivariate analysis to describe the effect of surgical technique and comorbidities on revision rate.
Conclusions: This study found a substantially lower rate of revision CTR (0.2%) in our practice than previously published studies. Large database studies that do not include a manual review of patient charts and operative notes may unintentionally over-report revision rates. The length of time to symptom recurrence following primary CTR may be highly variable.


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