Introduction: Carpal tunnel release is highly effective; however, a subset of patients develops persistent or recurrent symptoms requiring revision surgery. Failure may reflect incomplete decompression, perineural scarring, technical injury, or patient-related systemic and occupational factors. This study aimed to assess the incidence of revision surgery and identify its independent predictors following primary carpal tunnel release.

Material and methods: This retrospective, descriptive cross-sectional study was conducted at Imam Reza Hospital, Tabriz, Iran, and included 300 adults who underwent primary carpal tunnel release. Eligible records were selected through convenience sampling. Demographic, clinical, electrophysiological, surgical, postoperative, and revision-related data were extracted from medical records using a standardized form and analyzed statistically to determine the incidence and predictors of revision surgery.

Results: Revision carpal tunnel surgery occurred in 8.0% of patients. Multivariable logistic regression identified preoperative severe electrodiagnostic grade (adjusted OR=3.86, 95% CI:1.31–11.38; P=0.014), persistent postoperative pillar or scar pain (adjusted OR=3.41, 95% CI:1.18–9.85; P=0.023), primary endoscopic release (adjusted OR=3.25, 95% CI:1.04–10.15; P=0.043), preoperative thenar atrophy (adjusted OR=3.12, 95% CI:1.08–8.99; P=0.035), and diabetes mellitus (adjusted OR=2.94, 95% CI:1.05–8.24; P=0.040) as independent predictors of revision surgery.

Conclusion: Secondary revision following carpal tunnel release is primarily driven by advanced baseline neural degeneration, metabolic comorbidity, endoscopic decompression, and persistent postoperative pillar pain. Comprehensive preoperative electrodiagnostic risk stratification, careful surgical technique selection, and targeted glycemic management are essential to mitigate surgical failure rates and optimize long-term clinical recovery.