Endoscopic Versus Open Carpal Tunnel Release in Obese and Nonobese Patients

Purpose This study compared postoperative complications and revision rates following endoscopic versus open carpal tunnel release (CTR) in obese and nonobese patients. Methods A 2010–2022 national administrative database was queried to identify adults undergoing open or endoscopic CTR. Patients undergoing open and endoscopic CTR were each matched 1:1 for age, sex, diabetes, tobacco use, and Elixhauser Comorbidity Index in both the obese (body mass index > 30 kg/m²) and nonobese cohorts. Ninety-day complications and ipsilateral revision surgery within 5 years were compared using univariable and multivariable analysis for each cohort. Results In the obese matched cohort, endoscopic CTR was associated with lower rates of surgical site infection (0.46% vs 0.73%) and wound dehiscence (0.39% vs 0.72%) compared with open CTR (all P < .001). There was no significant difference in revision rates between endoscopic and open CTR (1.92% vs 2.01%, P = .466). On multivariable analysis, these associations remained significant (surgical site infection OR 0.62, 95% confidence interval [CI] 0.49–0.76 and wound dehiscence OR 0.53, 95% CI 0.42–0.67, all P < .001). In the nonobese cohort, endoscopic CTR was similarly associated with reduced rates of surgical site infection (0.30% vs 0.48%) and wound dehiscence (0.19% vs 0.40%) with corresponding reduced odds of surgical site infection (OR 0.64, 95% CI 0.59–0.70) and wound dehiscence (OR 0.47, 95% CI 0.43–0.52) (all P < .001). Revision rates were slightly higher in endoscopic versus open CTR (1.49% vs 1.39%, P = .007) for nonobese patients. There were no differences in hematoma or median nerve injuries in either cohort. Conclusions Endoscopic CTR was associated with a decrease in wound complications in both obese and nonobese patients. There were comparable rates of revision surgery and median nerve injuries between the 2 surgical approaches. However, the clinical differences were modest, and the choice of surgical approach may remain at the discretion of the treating surgeon. Type of study/level of evidence Therapeutic IIb (Oxford CEBM Level 2b. Retrospective comparative cohort study)