Patient-reported risk acceptance for complications of carpal tunnel release

Carpal tunnel release (CTR) is a common surgery with a well-described complication profile, but it is unclear whether patients' self-reported risk acceptance is higher than, equal to, or lower than actual surgical risks. We aimed to investigate patients' self-reported levels of risk acceptance for complications of CTR, factors associated with higher risk acceptance, and whether PROMIS Upper Extremity, PROMIS Pain Interference, and PROMIS Pain Intensity scores correlate with risk acceptance.

A prospective, cross-sectional study was conducted of 47 adult patients with idiopathic carpal tunnel syndrome (CTS) who were indicated for mini-open CTR using a standard published technique with a well-described complication profile. A standardized questionnaire was used to survey patients about the highest acceptable risk of infection, persistent or recurrent symptoms, and nerve or vessel injury as a percentage from 0 % to 100 %. Our explanatory variables included PROMIS Upper Extremity, PROMIS Pain Interference, PROMIS Pain Intensity, and other patient-related factors.

The median patient-reported risk acceptance for infection after CTR surgery was 30 % (interquartile range 10 %-50 %), for persistent or recurrent symptoms was 40 % (interquartile range 20 %-50 %), and for nerve or vessel injury was 20 % (interquartile range 10 %-50 %). Diabetes mellitus was associated with higher risk acceptance for nerve or vessel injury during CTR. Lower PROMIS Upper Extremity scores were weakly correlated with higher risk acceptance for nerve or vessel injury during CTR. Higher PROMIS Pain Interference scores were weakly correlated with higher risk acceptance for persistent or recurrent symptoms after CTR.

The actual risks of common complications after CTR are much lower than most patients' self-reported risk acceptance. The severity of preoperative CTS symptoms affects patients' acceptance of the risk of surgical complications and symptom persistence after CTR.