Improvement in Patient-Specific Outcomes After Carpal Tunnel Release in Patients Older Than 80 Years

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Abstract

Outcomes after carpal tunnel release (CTR) may be influenced by age, disease chronicity, and disease severity. Multiple studies report mixed results between age and improvement through a validated instrument, the Brigham and Women's Carpal Tunnel Questionnaire (BWQ). However, these investigations did not control for confounders and had small cohorts of younger patients. We hypothesized that patients older than 80 years have statistically significant improvement in symptom severity and functional status after CTR. Patients completed the BWQ preoperatively and postoperatively. The main outcome measurement was difference in average BWQ scores, verified with Wilcoxon signed rank test. A standardized response mean was used to calculate effect size. Covariates were based on potential confounders, such as body mass index, hypothyroidism, American Society of Anesthesiologists (ASA) status, and thenar electromyography findings. The t test or χ2 test was used for univariate analysis. Logistical regression predicted odds of large versus small improvement in BWQ scores in a multivariate model, which was assessed with receiver operating characteristic and Hosmer-Lemeshow tests. Statistically significant improvement was seen among the 44 patients who completed the BWQ, with symptom severity scores of 2.97 points; functional status scores, 1.52 points; and combined scores, 2.51 points. Age did not predict effect size; however, ASA status had a statistically significant inverse relation, with a decrease in the odds of large improvement by 77%. Age did not predict improvement in BWQ scores in a regression model analysis in 1 of the largest cohorts of patients older than 80 years who underwent CTR. Patients of this age do benefit from CTR. Although age is not associated with the size of this benefit, ASA status is associated, suggestive that other medical comorbidities adversely affect outcomes after CTR in this elderly population.

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