Endoscopic Versus Open Treatment of Carpal Tunnel Syndrome: Postoperative Complications in Patients With Diabetes Mellitus

Purpose: Patients with type 2 diabetes mellitus (T2DM) often face higher postoperative complication rates. Limited data exist regarding outcomes in T2DM patients undergoing carpal tunnel release (CTR). This study compares complication rates between endoscopic CTR (ECTR) and open CTR (OCTR) in patients with T2DM. Methods: The TriNetX database was used to perform a retrospective cohort study of 67,225 patients with T2DM who underwent ECTR (n = 17,792) or OCTR (n = 49,433). Demographic data, medical comorbidities, and complication rates were analyzed. A 1:1 propensity score match was performed to calculate risk ratios and 95% confidence intervals of postoperative median nerve injury, 6-week wound dehiscence, and 6-week wound infection. Results: After matching, a significantly greater number of ECTR patients had liver disease (P = <.001) and a body mass index > 40 (P = .001) compared to the OCTR group. These patients also had a lower incidence of fluid and electrolyte disorders (P = .003). Patients with T2DM who underwent ECTR had a significantly lower relative risk of 6-week wound infection, 6-week wound dehiscence, and median nerve injury (all P < .001) compared to patients who underwent OCTR. Conclusions: In our analysis of T2DM patients undergoing CTR, ECTR yielded significantly lower rates of wound infection, wound dehiscence, and nerve injury within 6-weeks post-surgery, reducing the risk by 43%, 52%, and 58%, respectively. These findings suggest that ECTR may result in a lower complication rate in this patient population. Type of study/level of evidence: III.