Endoscopic and Open Carpal Tunnel Release in Patients With Type II Diabetes Mellitus: Influence of Preoperative Semaglutide Use on Postoperative Outcomes.

PURPOSE: Patients with type II diabetes mellitus are at greater risk of carpal tunnel syndrome and of complications following carpal tunnel release (CTR). Although recent orthopedic literature suggests preoperative semaglutide use may reduce complication and reoperation rates, its impact has not been studied in hand surgery. Given the overall favorable complication profile of CTR, it remains unknown if similar risk modification exists. METHODS: Type II diabetes mellitus patients undergoing endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) were identified from the PearlDiver database. Exclusion criteria included the following: age <18, revision CTR, traumatic, neoplastic, or infectious diagnoses within 90 days before surgery, <90 days follow-up, and other concurrent upper-extremity procedures. Patients using semaglutide within 1 year before surgery were identified and matched 1:4 with (-)semaglutide controls. Ninety-day complications were compared by multivariable logistic regression, and 2-year reoperation was assessed by Kaplan-Meier survival analysis and log-rank test. RESULTS: Semaglutide was used by 689 (1.2%) of ECTR and 1,966 (0.8%) of OCTR patients. Once matched, there were 426 ECTR and 1,673 OCTR patients receiving semaglutide. Relative to ECTR (-)semaglutide controls, semaglutide reduced the odds of pneumonia (OR, 0.30 [0.13-0.58]) and urinary tract infection (OR, 0.28 [0.18-0.44]). Relative to OCTR (-)semaglutide controls, semaglutide reduced the odds of surgical site infection (SSI) (OR, 0.31 [0.18-0.51]), sepsis (OR, 0.61 [0.43-0.85]), wound dehiscence (OR, 0.25 [0.13-0.42]), pneumonia (OR, 0.26 [0.19-0.35]), and urinary tract infection (OR, 0.33 [0.27-0.40]). For both ECTR and OCTR, 2-year reoperation rates were similar for those with versus without semaglutide. CONCLUSIONS: The current study reinforces the low overall incidence of complications following CTR. The most clinically relevant findings were observed in OCTR patients, including reduced odds of SSI and wound dehiscence. However, 2-year reoperation rates were similar across both surgical approaches regardless of semaglutide use. These findings may have implications in the context of perioperative risk stratification. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.