Predictors of Successful Outcomes Following Revision Carpal Tunnel Release

We sought to identify predictors of successful revision carpal tunnel release (CTR) and compare long-term patient-reported outcomes to individuals who underwent primary CTR with no revision. We hypothesized that patients undergoing revision CTR would have worse patient-reported outcomes scores compared to primary CTR at 1-year follow-up.

We retrospectively compared 521 primary CTR and 57 revision CTR patients. Patients with minimum 1-year follow-up, including Patient-Reported Outcomes Measurement Information System (PROMIS) and Patient Acceptable Symptom State (PASS) scores, were included. PASS and PROMIS Upper Extremity (UE), Pain Interference (PI), and Physical Function (PF) were compared at before surgery and 1-year after surgery timepoints. Demographic and surgical data were compared using bivariate and multivariable analyses.

Compared with the primary CTR group, the revision group had a higher body mass index, was more likely to be male, have their dominant hand affected, have diabetes, undergo endoscopic CTR, and have concurrent cubital tunnel syndrome (CuTS). A chief complaint of pain (OR 0.23), tobacco use (OR 0.11), or diabetes (OR 0.22) were less likely to have a positive PASS response, whereas having an interval steroid injection (OR 6.2) was a predictor of a positive PASS response. PROMIS UE, PF, and PI were all similar in the primary group compared with the revision group at both before surgery and 1-year after surgery visits. None of the PROMIS modalities significantly improved at 1-year follow-up in the primary and revision groups compared to before surgery. Positive PASS response in the revision group was lower preoperatively and 1-year postoperatively compared with the primary cohort.

Steroid injections, absence of diabetes and tobacco use, and chief symptoms of paresthesias or weakness, rather than pain, are predictors of satisfactory outcomes after revision CTR. Patients undergoing revision demonstrated lower rates of positive PASS response than primary CTR without revision at 1-year follow-up.

Prognostic II.