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Endoscopic Versus Open Treatment Of Carpal Tunnel Syndrome: Postoperative Complications In Patients On Anticoagulation 
Arman Kishan, MBBS, Kiyanna Thomas, BS, Mark Haft, BS, Steve Li, BA, Sami H. Tuffaha, MD, Dawn Laporte, MD, Duc Nguyen, MD;
Johns Hopkins University School of Medicine, Baltimore, MD, USA

INTRODUCTION: Anticoagulation therapy often leads to higher postoperative complication rates. Limited data currently exists on the outcomes of patients undergoing carpal tunnel release (CTR) while on anticoagulation. Our goal is to compare complications in anticoagulated patients who had either endoscopic CTR (ECTR) or open CTR (OCTR) for CTS. METHODS: We retrospectively used the TriNet X database to identify patients on anticoagulation undergoing OCTR or ECTR. Analyzing demographic data, comorbidities, and complication rates, we employed multivariable analysis to detect differences in postoperative complications (wound infection, wound dehiscence, and intraoperative median nerve injury) between the two surgical methods. RESULTS SECTION: The study included 10,919 carpal tunnel syndrome patients on anticoagulation, with 9082 undergoing OCTR and 1837 undergoing ECTR. Among anticoagulated patients, ECTR showed significantly lower rates of 90-day wound infection (p < 0.001) and nerve injury (p < 0.001) compared to OCTR. However, there was no significant difference in the risk of 90-day wound dehiscence between the two groups (p = 0.323). DISCUSSION: OCTR previously showed fewer postoperative complications than ECTR overall. Our study reveals that for anticoagulated patients, ECTR significantly reduces 90-day wound infection and nerve injury by 35% and 40%, respectively. This implies anticoagulated patients might find ECTR more advantageous than OCTR.
Table 1. Matched Outcomes for Endoscopic Versus Open CTR in Patients on Anticoagulation 

OutcomesRR95% CIP-value
90-Day Wound Infection0.65(0.51-0.84)<0.001
Nerve Injury0.60(0.44-0.81)<0.001
90-Day Wound Dehiscence0.81(0.53-1.23)0.323

RR, Relative Risk; CI, Confidence Interval 

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