Great Evidence to Guide Shared Decision-making About Endoscopic CTR
Two studies, one new and one a couple years old, provide practical guidance for a common office conversation
What’s the Claim?
A large, single-center retrospective, comparative study found that endoscopic carpal tunnel release was independently associated with a nearly threefold increase in the odds of reoperation (95% CI 1.7 to 5.3) compared to open CTR. The overall percentage of patients having a reoperation in both groups was low, though — 2.1% in the endoscopic group and 0.7% in the open CTR group.
How’s It Stack Up?
The best comparator study to this one came from a large insurance database, and it found that 6.5% of patients treated endoscopically underwent revision decompression within one year, compared with 4.4% of patients who had an open CTR. A difference, yes, but a much smaller one — after controlling for confounding variables, that odds ratio is only 1.3 (95% CI 1.1 to 1.5), not something approaching three. Of the two studies, we tend to trust the older one from the insurance database more, for two reasons:
- It was less likely to have suffered from loss to follow-up (over such a short span, few patients were likely to have changed insurance coverage, and so all reoperations likely were captured)
- It represents the efforts of many more surgeons, rather than a select few academicians, and so probably is more generalizable
Both studies found slight increases in odds associated with smoking, diabetes, and concomitant cubital tunnel syndrome.