OBJECTIVE Carpal tunnel syndrome (CTS) presents bilaterally in nearly 60%-70% of affected patients. Bilateral carpal tunnel release (CTR) can be performed in a staged or simultaneous fashion. There remains a limited understanding of the optimal preoperative factors to use for patient selection when determining simultaneous versus staged bilateral CTR. Moreover, it is unclear how these factors influence postoperative outcomes. In this study, the authors aimed to identify and compare preoperative comorbidities and postoperative outcomes in patients who had undergone simultaneous versus staged open and endoscopic bilateral CTR. METHODS The authors performed a retrospective analysis of data collected from the TriNetX database. Patients with bilateral CTS who had been treated from February 1, 2002, to February 1, 2022, were dichotomized by their bilateral release approach: simultaneous or staged within 3 months. The resulting groups were analyzed separately by open versus endoscopic techniques. Next, cohorts were analyzed for preoperative comorbidities to identify possible factors for surgical determination. Then, they were propensity score matched on demographics and comorbidities. Postoperative outcomes within 6 months of surgery were measured with and without matching. RESULTS After matching, 9286 and 3709 patients remained in the open and endoscopic groups, respectively. Those who had undergone staged surgeries via an open or endoscopic approach had more preoperative comorbidities. After matching, staged open release was associated with significantly higher rates of postprocedural care, hand/joint pain, limb pain, trigger finger, and upper respiratory tract infections. Simultaneous open release was associated with higher rates of emergency room visits. Staged endoscopic release was associated with significantly higher rates of postprocedural care, limb pain, and trigger finger. No significant outcomes were favored in the simultaneous endoscopic group. CONCLUSIONS Before matching, patients who had undergone staged CTR had significantly higher rates of preoperative medical comorbidities compared with patients in the simultaneous CTR group. Moreover, staged CTR was significantly associated with higher rates of postoperative complications. After matching on demographics and comorbidities, staged CTR was still associated with higher rates of postoperative complications, suggesting that preoperative comorbidities do not influence postoperative outcome. Further prospective studies could be used to validate these results and provide new findings for the management and treatment of these groups.

中文翻译：

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通过开放和内窥镜手术同时与分阶段双侧腕管松解术：回顾性倾向评分匹配的患者合并症分析。

目的 近 60%-70% 的受影响患者双侧出现腕管综合征 (CTS)。双侧腕管松解术 (CTR) 可以分阶段或同时进行。在确定同时与分阶段双侧 CTR 时，对于用于患者选择的最佳术前因素的了解仍然有限。此外，尚不清楚这些因素如何影响术后结果。在这项研究中，作者的目的是识别和比较接受同时与分期开放和内窥镜双侧 CTR 的患者的术前合并症和术后结果。方法 作者对从 TriNetX 数据库收集的数据进行了回顾性分析。2002 年 2 月 1 日至 2022 年 2 月 1 日期间接受治疗的双侧 CTS 患者根据双侧释放方法分为两类：同时释放或 3 个月内分期释放。通过开放技术与内窥镜技术分别对所得组进行分析。接下来，对队列进行术前合并症分析，以确定手术决定的可能因素。然后，他们根据人口统计数据和合并症进行倾向评分匹配。在匹配和不匹配的情况下测量手术后 6 个月内的术后结果。结果 匹配后，开放组和内镜组分别有 9286 名和 3709 名患者。通过开放或内窥镜方法进行分期手术的患者术前合并症较多。匹配后，分阶段开放释放与术后护理、手/关节疼痛、四肢疼痛、扳机指和上呼吸道感染的发生率显着升高相关。同时开放释放与急诊室就诊率较高有关。分阶段内镜松解与术后护理、肢体疼痛和扳机指的发生率显着升高相关。同时内窥镜组没有取得显着的结果。结论 在匹配之前，接受分期 CTR 的患者术前合并症的发生率明显高于同步 CTR 组的患者。此外，分期 CTR 与术后并发症发生率较高显着相关。在对人口统计数据和合并症进行匹配后，分期 CTR 仍然与较高的术后并发症发生率相关，这表明术前合并症不会影响术后结果。进一步的前瞻性研究可用于验证这些结果，并为这些群体的管理和治疗提供新的发现。