Surgical Risk Following Carpal Tunnel Release in Non-cirrhotic Non-alcoholic Fatty Liver Disease Versus Non-alcoholic Cirrhosis: A Propensity-Matched Analysis

Background Non-alcoholic fatty liver disease (NAFLD) and its progression to non-alcoholic cirrhosis (NAC) frequently coexist with metabolic and musculoskeletal conditions, including carpal tunnel syndrome. While cirrhosis is a known risk factor for adverse surgical outcomes, its effect on low-acuity orthopedic procedures such as carpal tunnel release (CTR) remains unclear. This study compares perioperative outcomes following CTR in patients with NAFLD versus NAC. Methodology This retrospective cohort analysis screened 334,595 CTR patients, from which 1,516 with NAC and 6,427 with NAFLD were identified. After one-to-one matching based on age, gender, Charlson Comorbidity Index (CCI), and key comorbidities, 642 patients per group were analyzed. In this study, 90-day and one-year postoperative complications were identified using the International Classification of Diseases and Current Procedural Terminology codes. Multivariable logistic regression models adjusted for age, sex, and CCI. Cost outcomes were evaluated using both the Wilcoxon rank-sum and t-tests comparing 90-day reimbursement data between matched cohorts. Results Patients with NAC had significantly higher rates of deficiency anemia and lower rates of obesity compared to those with NAFLD. No statistically significant differences were observed in 90-day complications, but at one year, cirrhotic patients were more likely to develop acute kidney injury (AKI). Cost analysis showed that patients with NAC had higher mean 90-day reimbursements than those with NAFLD, though the difference was not statistically significant. Conclusions Patients with NAC experienced a higher risk of AKI at one year compared to those with NAFLD, but this may be attributed to hepatorenal syndrome that cirrhotic patients experience. These findings suggest that hepatic disease severity may not significantly influence postoperative outcomes, and patients with more advanced liver pathology may not require increased perioperative surveillance compared with those with NAFLD following CTR.