Timing of Corticosteroid Injection Before Endoscopic Carpal Tunnel Release Influences Wound Complication Rates

Background: Endoscopic carpal tunnel release (CTR) is an alternative to open CTR, which may have improved wound healing. Corticosteroid injections (CSIs) may increase postoperative wound complications and are commonly used for nonoperative management. Given these competing effects, this study sought to determine whether the timing of CSI prior to endoscopic CTR would influence postoperative wound-complication rates. Methods: A national claims database was retrospectively queried for patients undergoing endoscopic CTR between 2010 and 2023. Patients were stratified based on preoperative CSI timing: <1, 1 to 3, 6 to 12 months, with no preoperative CSI within 1 year as a comparator. These were propensity score matched, using demographic and comorbidity factors. Primary outcomes included a composite of infectious and noninfectious wound complications and irrigation and debridement within 3 months postoperatively. Multivariable logistic regression compared patients with and without a recent history of CSI and their association with wound complications. Results: In total, 24 013 patients with a history of preoperative CSI were matched to 70 918 patients without a CSI history with good balance. When compared with patients without a CSI history, patients who were administered a CSI < 1 month (1.72 [95% confidence interval (CI): 1.21-2.38, P = .002]) and 1-3 months (1.48 [95% CI: 1.16-1.86, P = .001]) before their endoscopic CTR were at significantly greater adjusted odds of composite wound complications. Conclusions: Endoscopic CTR is associated with equivalent wound complications when compared with those without a preoperative CSI if performed ≥3 months after CSI.