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Diabetes and endocrinology
Research
Open carpal tunnel release and diabetes: a retrospective study using PROMs and national quality registries
  1. Malin Zimmerman1,2,
  2. Katarina Eeg-Olofsson M.D, PhD3,4,
  3. Ann-Marie Svensson RN, PhD5,
  4. Mikael Åström6,
  5. Marianne Arner7,8,
  6. Lars Dahlin1,2
  1. 1 Department of Translational Medicine – Hand Surgery, Lund University, Lund, Sweden
  2. 2 Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
  3. 3 Department of Medicine, University of Gothenburg, Göteborg, Sweden
  4. 4 Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
  5. 5 National Diabetes Register, Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
  6. 6 Department of Data Analytics and Register Centre, Region Skåne Hälso- och sjukvård, Lund, Sweden
  7. 7 HAKIR, National Registry for Hand Surgery, Stockholm South General Hospital, Stockholm, Sweden
  8. 8 Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Malin Zimmerman; malin.zimmerman{at}med.lu.se

Abstract

Objectives To study patient-reported outcome after open carpal tunnel release (OCTR) for carpal tunnel syndrome (CTS) in patients with or without diabetes using national healthcare quality registries.

Design Retrospective cohort study.

Setting Data from the Swedish National Quality Registry for Hand Surgery (HAKIR; www.hakir.se) were linked to data from the Swedish National Diabetes Register (NDR; www.ndr.nu).

Participants We identified 9049 patients (10 770 hands) operated for CTS during the inclusion period (2010–2016).

Primary outcome measures Patient-reported outcome measures were analysed before surgery and at 3 and 12 months postoperatively using the QuickDASH as well as the HAKIR questionnaire with eight questions on hand symptoms and disability.

Results Patients with diabetes (n=1508; 14%) scored higher in the QuickDASH both preoperatively and postoperatively than patients without diabetes, but the total score change between preoperative and postoperative QuickDASH was equal between patients with and without diabetes. The results did not differ between patients with type 1 or type 2 diabetes. Patients with diabetic retinopathy scored higher in QuickDASH at 3 months postoperatively than patients with diabetes without retinopathy. In the regression analysis, diabetes was associated with more residual symptoms at 3 and 12 months postoperatively.

Conclusions Patients with diabetes experience more symptoms both before and after OCTR, but can expect the same relative improvement from surgery as patients without diabetes . Patients with retinopathy, as a proxy for neuropathy, may need longer time for symptoms to resolve after OCTR. Smoking, older age, higher HbA1c levels and receiving a diabetes diagnosis after surgery were associated with more residual symptoms following OCTR.

  • carpal tunnel syndrome
  • open carpal tunnel syndrome
  • diabetes
  • diabetes complications
  • glycated hemoglobin A
  • diabetic retinopathy

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-030179

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    Footnotes

    • Contributors MZ did the calculations and wrote the draft of the manuscript. KE-O and A-MS contributed to acquisition and interpretation of the data from NDR. MÅ revised data analysis and interpretations. MA acquired data from HAKIR. LD designed the study and contributed to interpretations. All authors contributed to data interpretation, the article draft and revision of the paper. All authors have approved the final version of the manuscript.

    • Funding This work was supported by grants from the Lund University, the Swedish Diabetes Foundation, Sydvästra Skånes Diabetesförening and Region Skåne (Skåne University Hospital Malmö-Lund), Sweden. The study sponsors were not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.

    • Competing interests None declared.

    • Patient and public involvement statement Patients were not directly involved in the design and conception of this study.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol has been approved by the Regional Ethical Review Boards in Lund and Stockholm, Sweden, Dnr 2016/931 and Dnr 2017/2023-31.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.