In our unit carpal tunnel release (CTR) is performed by surgeons from every grade, with and without supervision. An audit of complications following CTR, relative to published rates, was undertaken, with emphasis on outcomes of those performed by junior surgeons.
A retrospective review of all cases of primary CTR performed in Waikato DHB over a 6 month period between 01/06/21 and 30/11/21, with a minimum 6 months’ follow-up was performed. Outcomes were compared against published data from a PubMed search.
Seventy two carpal tunnel releases were performed. Mean patient age was 59.6. Thirty six releases were performed by junior registrars, 4 by senior registrars, 28 by MOSS and 4 by SMOs. 10% of cases were performed under general anaesthetic; the rest under local - no tourniquet technique. GA cases were performed under tourniquet control and were usually in combination with other procedures.
There was a 2.8% total complication rate and 1 case required admission for post operative infection. Closure techniques included monofilament permanent and braided absorbable sutures, with no difference in infection rate between the two.
60% of patients had complete resolution of symptoms, 28% partial resolution and 10% of patients were lost to follow up or did not attend their clinic appointments. 1 patient had no improvement to their symptoms. Pre-op investigations were reviewed: 5 patients had had pre-op diagnostic steroid injections and 10 patients had pre-op nerve conduction studies. There was no correlation between results of these pre-op tests and the degree of resolution of symptoms after surgery.
A carpal tunnel release service that relies heavily on registrar-provided operating seems to have similar complication rates to the literature, and provides both valuable exposure for junior surgeons alongside a high patient turnover in a tertiary centre.