The risk of complications after carpal tunnel release in patients taking acetylsalicylic acid as platelet inhibition – A multi-center propensity score-matched study

BACKGROUND:Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence, whether platelet inhibitors increase the risk to develop post-operative 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. Primary study-endpoint was of post-operative bleeding complication defined as acute bleeding leading to re-operation 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%). 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 BMI might have a beneficial effect (p=0.006). Patients with post-operative 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 out of 10 points and did not differ significantly between the anti-platelet and the non anti-platelet cohort (p=0.072) CONCLUSIONS:Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication.