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Prediction tool may indicate likelihood of contralateral CTR

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BOSTON — Using a validated prediction model when a patient undergoes unilateral carpal tunnel release surgery may make it possible to predict the patient’s eventual need for contralateral carpal tunnel release surgery, according to results presented here.

Dafang Zhang

To determine identifiable predictors for a future contralateral carpal tunnel release (CTR), Dafang Zhang, MD, and colleagues retrospectively studied 1,013 patients who underwent unilateral CTR at a secondary tertiary care referral center who had a median 5.5-year follow-up. Zhang said 88% and 75% of patients had an ipsilateral nerve conduction study and contralateral nerve conduction study, respectively, prior to CTR surgery.

“We found that 350 of 1,013 patients ended up having a contralateral carpal tunnel release within our follow-up period. This was 35%,” Zhang said at the American Society for Surgery of the Hand Annual Meeting.

Contralateral carpal tunnel symptoms and preoperative contralateral nerve conduction study severity were positive predictors of contralateral CTR. Chronic kidney disease diagnosis and Black race were negative predictors of contralateral CTR, Zhang said.

The researchers used these predictive variables to generate a prediction formula for the probability of undergoing contralateral CTR in the future 5.5 years.

“Depending on the input of the four predictive variables, we were able to generate a predictive probability of future carpal tunnel release that ranges from 0% to 70% at 5.5 years,” Zhang said.

Researchers used predictive variables to generate a prediction formula for the probability of undergoing contralateral CTR in the future 5.5 years.

Casey Tingle

This prediction formula was externally validated using 100 patients from a secondary tertiary referral center in the same geographic region who had similar characteristics to the initial cohort but had a different prevalence of chronic kidney disease and race.

“However, our model remained moderately predictive with good validity,” Zhang said. – by Casey Tingle

Reference:

Zhang D, et al. Paper 03. Presented at: American Society for Surgery of the Hand Annual Meeting; September 13-15, 2018; Boston.

Disclosure: Zhang reports no relevant financial disclosures.