Improved Outcomes With Endoscopic Carpal Tunnel Release for Patients With Nicotine Dependence

BACKGROUND: The optimal surgical strategy for carpal tunnel release remains a subject of debate. This study compared the perioperative complication rates of endoscopic and open carpal tunnel release for the treatment of carpal tunnel syndrome in patients with nicotine dependence. METHODS: The TriNetX database was queried to conduct a retrospective cohort study, identifying a total of 22 435 open carpal tunnel releases and 4947 endoscopic carpal tunnel releases performed on patients with nicotine dependence. Short-term, 90-day complication rates were assessed across both cohorts, including hospital admissions, postoperative emergency department (ED) visits, infections, nerve injury, renal injury, and thrombotic events. Propensity score-matched analyses were performed to mitigate the risk of confounding. RESULTS: After adjusting for demographic and comorbidity variables, patients with nicotine dependence undergoing open carpal tunnel release had increased risk of postoperative admission (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9), ED visit (OR = 1.2, 95% CI = 1.1-1.4), median nerve injury (OR = 2.0, 95% CI = 1.0-4.7), and superficial infections (OR = 2.2, 95% CI = 1.7-2.8) compared with the endoscopic carpal tunnel release cohort. CONCLUSION: Patients with nicotine dependence who undergo open carpal tunnel release experience higher 90-day perioperative complication rates compared with those receiving endoscopic carpal tunnel release. This effect persisted in both unmatched and matched analyses, suggesting an endoscopic technique may be preferable in patients with nicotine dependence due to lower short-term complication risk.