Risk of Amyloidosis and Heart Failure Among Patients Undergoing Surgery for Trigger Digit or Carpal Tunnel Syndrome: A Nationwide Cohort Study With Implications for Screening

Ravi F Sood; Angelo B Lipira

doi:10.1016/j.jhsa.2022.01.022

Risk of Amyloidosis and Heart Failure Among Patients Undergoing Surgery for Trigger Digit or Carpal Tunnel Syndrome: A Nationwide Cohort Study With Implications for Screening

J Hand Surg Am. 2022 Jun;47(6):517-525.e4. doi: 10.1016/j.jhsa.2022.01.022. Epub 2022 Mar 26.

Authors

Ravi F Sood¹, Angelo B Lipira²

Affiliations

¹ Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA. Electronic address: rfsood@uw.edu.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR; Operative Care Division, Portland VA Medical Center, Portland, OR.

PMID: 35346527
DOI: 10.1016/j.jhsa.2022.01.022

Abstract

Purpose: Tenosynovial biopsy during carpal tunnel release (CTR) leads to an earlier diagnosis of amyloidosis. Surgery for trigger digit-trigger release (TR)-may provide a similar opportunity. We sought to characterize the risk of amyloidosis diagnosis after TR and/or CTR.

Methods: We conducted a retrospective cohort study of adults without diagnosed amyloidosis undergoing TR and/or CTR in the Veterans Health Administration from 1999 to 2019, including matched controls. We used competing-risks methodology to estimate the cumulative incidence and adjusted subdistribution hazard ratios (sHRs) of amyloidosis, heart failure, and death after TR and/or CTR.

Results: Among the 126,788 patients undergoing TR and/or CTR, amyloidosis was diagnosed in 52 of 26,757 patients undergoing TR alone at a median of 4.7 years after surgery (10-year cumulative incidence: 0.26%, 95% CI: 0.18% to 0.34%), 396 of 91,384 patients undergoing CTR alone at a median of 5.1 years after surgery (10-year cumulative incidence: 0.60%, 95% CI: 0.53% to 0.67%), 50 of 8,647 patients undergoing both TR and CTR at a median of 3.1 years after surgery (10-year cumulative incidence: 0.80%, 95% CI: 0.54% to 1.1%), and 54 of 113,452 controls at a median of 5.0 years after the index date (10-year cumulative incidence 0.053%, 95% CI: 0.037% to 0.070%). In the adjusted analysis, patients who underwent TR and/or CTR had a higher risk of amyloidosis (TR: sHR_adj 4.80, 95% CI: 3.33-6.92; CTR: sHR_adj 10.2, 95% CI: 7.74-13.6; TR and CTR: sHR_adj 14.9, 95% CI: 9.87-22.5) and heart failure (TR: sHR_adj 1.91, 95% CI: 1.83-1.99; CTR: sHR_adj 2.02, 95% CI: 1.97-2.07; TR and CTR: sHR_adj 2.18, 95% CI: 2.04-2.33) but not death compared with the controls. Among the patients who underwent TR, age, Black race, prior CTR, heart failure, and the number of digits released were independent risk factors for amyloidosis.

Conclusions: Patients undergoing TR and/or CTR are at increased risk of incident amyloidosis and heart failure compared to controls.

Type of study/level of evidence: Prognostic II.

Keywords: Amyloidosis; carpal tunnel syndrome; heart failure; screening tenosynovial biopsy; trigger digit.

MeSH terms

Adult
Amyloidosis* / diagnosis
Amyloidosis* / epidemiology
Carpal Tunnel Syndrome* / diagnosis
Carpal Tunnel Syndrome* / epidemiology
Carpal Tunnel Syndrome* / surgery
Cohort Studies
Heart Failure* / complications
Heart Failure* / etiology
Humans
Retrospective Studies
Trigger Finger Disorder* / epidemiology
Trigger Finger Disorder* / etiology
Trigger Finger Disorder* / surgery