Introduction <p>Carpal Tunnel Syndrome (CTS) is a painful orthopedic hand condition caused by compression of the median nerve at the wrist. Diagnosis is typically clinical, relying on patient’s symptoms and physical examination findings, but confirmation often requires electrodiagnostic studies. Previous research on CTS has explored the relationship between median nerve compression severity and various outcomes. However, these studies have been limited by short follow-up durations, small to modest patient cohorts, and a narrow focus on patient-reported outcomes. The objective of this study was to provide a long-term, 10-year follow-up with a relatively large patient cohort, focusing on new patient-reported outcomes and their association with the severity of nerve compression.</p> Methods <p>A retrospective cohort study was conducted on a total of 581 patients who underwent open carpal tunnel release surgery between 2013 and 2023 at a major teaching hospital in Jordan. Severity was categorized based on nerve conduction study results into three groups: mild, moderate, and severe and Six distinct outcomes of interest were examined.</p> Results <p>No significant differences in age, health profiles, comorbidities, or disease presentation were observed among the severity groups. However, significant variations were found across the six outcomes. Patients with severe disease had longer recovery times (<i>p</i> &lt; 0.01), less pain relief (<i>p</i> = 0.03), reduced satisfaction (<i>p</i> = 0.04), diminished functional improvement (<i>p</i> &lt; 0.01), lower ADL improvement (<i>p</i> &lt; 0.01), yet experienced better sleep quality improvement (<i>p</i> &lt; 0.01).</p> Conclusion <p>Long-term follow-up post-open carpal tunnel release surgery revealed that severe cases experienced longer recovery times, less pain relief, reduced satisfaction, diminished functionality improvement, and lower ADL improvement, but better sleep quality.</p> Level of evidence <p>Level III, Retrospective cohort study.</p>