Systemic Amyloidosis and Postoperative Outcomes After Carpal Tunnel Release: A Propensity Score–Matched Cohort Study

BACKGROUND: Carpal tunnel syndrome (CTS) is common, and carpal tunnel release (CTR) is frequently performed with low complication rates. Amyloidosis has been linked to CTS pathophysiology, but data on postoperative CTR outcomes in patients with systemic amyloidosis are limited. We assessed whether systemic amyloidosis is associated with early postoperative complications or subsequent CTS-related care after CTR. METHODS: We performed a retrospective, 1:1 propensity score-matched cohort study using the TriNetX federated electronic health record (EHR) network. Adults (≥18 years) with CTS who underwent open or endoscopic CTR within 6 months of diagnosis were included, and the CTR date served as the index. Patients with a diagnosis of amyloidosis recorded on or before index were matched to controls without amyloidosis on demographics, comorbidities, CTR technique, prior carpal tunnel injection, and systemic corticosteroid exposure. Outcomes were assessed in 2 prespecified windows: early postoperative wound-related complications (post-index days 1-30) and intermediate-term symptom-driven care (post-index days 90-365). We estimated absolute risk differences, risk ratios, and Cox hazard ratios with 95% CIs. RESULTS: After matching, 943 patients remained in each cohort with 1-year follow-up. No statistically significant differences were observed for early postoperative complications within 30 days of CTR (infection, wound disruption, or postprocedural bleeding and hematoma) or intermediate-term outcomes between 90 and 365 days (subsequent CTR, nerve conduction studies, or steroid injection). Time-to-event analyses were consistent with these findings. CONCLUSIONS: In this propensity-matched EHR cohort, recorded diagnosis of amyloidosis was not associated with higher early complication rates or increased 1-year downstream care after CTR.