Matched Cohort Study of Wound-Healing Complications in Patients With and Without Diabetes Mellitus After Primary Open Carpal Tunnel Release

Abstract

Purpose: Diabetes mellitus (DM) is associated with increased rates of wound complications and reduced improvement in patient-reported outcomes across a wide range of surgical disciplines, although the impact of DM is less known after primary carpal tunnel release (CTR). This study’s hypothesis was that DM would be an independent risk factor for wound complications after CTR. Methods: This retrospective, matched, cohort study evaluated all diabetic patients with a preoperative hemoglobin A1c value within 90 days of open primary CTR at a single academic institution from 2007 to 2017. Records were reviewed to determine rates of superficial or deep surgical site infection and delayed wound healing or wound dehiscence. Additional procedures, bilateral procedures, and administration of perioperative antibiotics were also noted. We calculated unadjusted and adjusted odds ratios and 95% confidence intervals to determine differences in all-cause and specific wound complication rates between patients with and without DM. Results: Diabetic patients (n = 128) had an all-cause wound complication rate, surgical site infection rate, and delayed wound healing or wound dehiscence rate of 11 (8.6%), 5 (3.9%), and 6 (4.7%), respectively, compared with 8 (6.3%), 2 (1.6%), and 6 (4.7%), respectively, for nondiabetic patients (n = 128). Diabetes was not significantly associated with an increased rate of all-cause wound complications at an unadjusted odds ratio of 1.41 (range, 0.55–3.63). Rates of specific wound complications also did not differ significantly, although superficial surgical site infections were more common among patients with DM at an unadjusted odds ratio of 5.16 (range, 0.59–44.82). Conclusions: Adjusted all-cause wound complication rates did not differ significantly in a matched cohort series. Superficial surgical site infections occurred at a higher rate in patients with DM, although this difference was not statistically significant. The presence of DM is not a contraindication to proceed with CTR in symptomatic patients. Type of study/level of evidence: Therapeutic III. Key words: Carpal tunnel release, cohort, diabetes, surgical site infection, wound healing