TY - JOUR
T1 - The Risk of Complications after Carpal Tunnel Release in Patients Taking Acetylsalicylic Acid as Platelet Inhibition
T2 - A Multicenter Propensity Score-Matched Study
AU - Kaltenborn, Alexander
AU - Frey-Wille, Stefanie
AU - Hoffmann, Sebastian
AU - Wille, Jörn
AU - Schulze, Christoph
AU - Settje, Andreas
AU - Vogt, Peter M
AU - Gutcke, André
AU - Ruettermann, Mike
PY - 2020/2
Y1 - 2020/2
N2 - BACKGROUND: Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release.METHODS: This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed.RESULTS: Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
AB - BACKGROUND: Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release.METHODS: This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed.RESULTS: Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
KW - Adult
KW - Aspirin/adverse effects
KW - Carpal Tunnel Syndrome/surgery
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Satisfaction/statistics & numerical data
KW - Platelet Aggregation Inhibitors/adverse effects
KW - Postoperative Hemorrhage/chemically induced
KW - Propensity Score
KW - Regression Analysis
KW - Retrospective Studies
KW - Risk Factors
U2 - 10.1097/PRS.0000000000006465
DO - 10.1097/PRS.0000000000006465
M3 - Original Article
C2 - 31985640
SN - 0032-1052
VL - 145
SP - 360e-367e
JO - PLASTIC AND RECONSTRUCTIVE SURGERY
JF - PLASTIC AND RECONSTRUCTIVE SURGERY
IS - 2
ER -