PURPOSE:
To establish the incidence of revision carpal tunnel surgery within a 1-year postoperative period using a national administrative database. This information has been unknown until this point because of the absence of laterality-specific coding with the International Classification of Diseases, Ninth Edition and earlier coding systems.

METHODS:
Data were collected from the Humana insurance database using PearlDiver patient records from 2015 to 2017. Subjects were identified using Current Procedural Terminology and International Classification of Diseases procedure codes related to carpal tunnel diagnosis and release. Codes were used to identify patients who underwent carpal tunnel release (CTR) and had revision CTR within a 1-year follow-up period. Patient demographic characteristics, including age, sex, medical comorbidities, and smoking status, were collected. In addition, multivariable analysis of the risk of a revision procedure within 1 postoperative year was performed to determine independent risk factors, including the surgical approach, associated with revision CTR.

RESULTS:
Among 4,549 patients who underwent a primary CTR during the study period, 207 patients (4.8%) underwent a revision CTR within 1 year. The average time from the primary CTR to the revision CTR was 135 days (standard deviation, 99.1 days; range, 21-365 days). Primary endoscopic CTR was associated with an increased rate of revision CTR (odds ratio, 1.3; 95% confidence interval, 1.2-1.6). Patient factors associated with a higher likelihood of requiring revision CTR included diabetes mellitus, tobacco use, psychiatric condition, cervical disease, and history of cubital tunnel release.

CONCLUSIONS:
This study identified a rate of revision CTR of 4.8% within the first postoperative year. Both the surgical technique and patient-specific risk factors influence the likelihood of requiring revision surgery. Notably, an endoscopic approach is associated with a higher risk of revision surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE:
Prognostic II.





Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
80% Article relates to my practice (8/10)
0% Article does not relate to my practice (0/10)
20% Undecided (2/10)
2

Will this article lead to more cost-effective healthcare?

50% Yes (5/10)
40% No (4/10)
10% Undecided (1/10)
3

Was this article biased? (commercial or personal)

0% Yes (0/10)
80% No (8/10)
20% Undecided (2/10)
4

What level of evidence do you think this article is?

0% Level 1 (0/10)
50% Level 2 (5/10)
40% Level 3 (4/10)
10% Level 4 (1/10)
0% Level 5 (0/10)