Effects of obstructive sleep apnea on postoperative outcomes following carpal tunnel release: A matched cohort analysis

Obstructive sleep apnea (OSA) has been linked to adverse perioperative outcomes in major orthopedic surgeries, yet its impact on minor ambulatory procedures such as carpal tunnel release (CTR) remains poorly understood. This study aimed to assess whether OSA is associated with increased postoperative complications following CTR. A retrospective cohort analysis was conducted using the PearlDiver national insurance claims database to identify patients who underwent CTR between 2010 and 2021. Of 315,809 identified cases, 231,598 met inclusion criteria. Patients with a documented diagnosis of OSA prior to surgery (n = 42,040) were matched 1:1 to controls without OSA (n = 36,561 per group) based on age category (<55 vs. ≥55 years) and sex. Preoperative comorbidities were assessed using ICD codes, and postoperative complications within 90 days were identified using CPT and ICD codes. Multivariable logistic regression models were used to adjust for age, sex, Charlson Comorbidity Index, and relevant comorbidities. A total of 73,122 patients were included (36,561 per cohort). The OSA group had higher rates of several comorbidities, including obesity, hypertension, COPD, CHF, and pulmonary hypertension (all p < 0.001). On adjusted analysis, OSA was associated with an increased risk of deep vein thrombosis (OR 0.56; 95% CI, 0.37–0.84; p = 0.006) and a small but statistically significant increase in the risk of any postoperative complication (OR 0.93; 95% CI, 0.86–0.99; p = 0.030). No significant differences were observed in surgical site infection, pulmonary embolism, wound disruption, readmission, or reoperation rates. Although CTR is generally considered a low-risk procedure, patients with OSA experienced modestly elevated postoperative complication rates, particularly for thromboembolic events. These findings suggest that OSA may contribute to perioperative risk even in minor hand surgeries and support the need for individualized preoperative assessment and perioperative planning in this population.