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Does Autoimmune Rheumatic Disease Influence Outcomes of Carpal Tunnel Release? A Retrospective Review

Irene A. Chang BA, Ying Ku BS, Michael W. Wells MEng, Lianne Mulvihill BS, Anthony DeLeonibus MD, Samantha Maasarani MD, Bahar Bassiri Gharb MD PhD, Antonio Rampazzo MD PhD
Cleveland Clinic
2023-02-10

Presenter: Irene Chang

Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.

Director Name: Steven Bernard

Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand

Background:
Few studies have investigated outcomes of carpal tunnel release (CTR) in rheumatic disease patients. Our aim was to determine predictive factors associated with increased complication and revision rates in this population.

Methods:
Between 2010 and 2020, CTR patients with autoimmune rheumatic disease were compared to matched controls at our institution. Univariate regression analysis was performed to study associations with demographics, comorbities, laterality, surgery type, and preoperative severity.

Results:
Of 5362 patients, 530 (9.9%) had autoimmune rheumatic disease including rheumatoid arthritis (n = 275, 51.9%), psoriasis (n = 129, 24.3%), Sjogren's syndrome (n = 62, 11.7%), lupus (n = 30, 5.7%), IBD (n = 29, 5.5%), vasculitis (n = 22, 4.2%), scleroderma (n = 14, 2.6%), dermatomyositis (n = 3, 0.6%), and polymyositis (n = 3, 0.6%). The autoimmune cohort had significantly higher revision (2.8% vs 1.1%, p = 0.04) and complication (24.0% vs 5.8%, p < 0.001) rates than controls. Complications included pain and paresthesia (n = 103, 19.4%), surgical site infection (n = 19, 3.6%), wound dehiscence (n = 10, 1.9%), and reoperation (n = 15, 2.8%). DASH scores were not statistically different between groups (p = 0.12).

Older age was the only predictive factor of reoperation in the study population. No other variables were predictive of complication rate in either groups or revision in controls.

Conclusion:
Autoimmune rheumatic disease has significantly higher rates of CTR revision and complications than the general population. Age increases the risk of CTR revision surgery in rheumatic disease patients.

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