Thirty-Day Reoperation and/or Admission After Elective Hand Surgery in Adults: A 10-Year Review

Avi D Goodman; Joseph A Gil; Adam M Starr; Edward Akelman; Arnold-Peter C Weiss

doi:10.1016/j.jhsa.2017.10.015

Thirty-Day Reoperation and/or Admission After Elective Hand Surgery in Adults: A 10-Year Review

J Hand Surg Am. 2018 Apr;43(4):383.e1-383.e7. doi: 10.1016/j.jhsa.2017.10.015. Epub 2017 Nov 15.

Authors

Avi D Goodman¹, Joseph A Gil², Adam M Starr³, Edward Akelman², Arnold-Peter C Weiss²

Affiliations

¹ Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI. Electronic address: Avi_goodman@brown.edu.
² Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
³ Department of Orthopaedics, Brooke Army Medical Center, JBSA Fort Sam Houston, TX.

PMID: 29150192
DOI: 10.1016/j.jhsa.2017.10.015

Abstract

Purpose: Whereas acute complications following elective hand surgery have been assumed to be rare, the incidence of 30-day unplanned reoperation and/or admission for the most common elective procedures has not been well described. Our goal was to calculate the incidence and identify the risk factors associated with these complications in a busy academic practice.

Methods: Our institution's quality assurance database was examined retrospectively for unplanned reoperations and/or admissions within 30 days in adults undergoing elective procedures with 2 senior attending surgeons from February 2006 to January 2016. Each event was categorized by causative factor and charts were reviewed to establish risk factors and cultured organisms. Our billing database was examined for the concomitant procedural volume.

Results: In our cohort of 18,081 surgeries (57.6% carpal tunnel or trigger digit releases), 27 patients had an unplanned reoperation and/or admission within 30 days (0.15% total incidence; including carpal tunnel release, 0.10%; trigger digit release, 0.09%; major wrist surgery, 0.74%) including 17 infections (0.09%). These were unevenly distributed over time after surgery with 29.6% occurring within 7 days, 59.2% in 8 to 14 days, 11.1% in 15 to 21 days, and none between 22 and 30 days.

Conclusions: Reoperations and/or unplanned admission within 30 days after elective hand surgery are infrequent (15 per 10,000 cases) and are most commonly related to infections (63.0%). More invasive surgeries are associated with a higher incidence than simpler procedures, and these complications are most likely to occur within 3 weeks after surgery. These data in elective patients do not cover certain clinically relevant outcomes, such as chronic pain or limited function, and may not be generalizable to all practices.

Type of study/level of evidence: Therapeutic IV.

Keywords: Complications; admission; infections; outcomes; reoperation.

MeSH terms

Ambulatory Surgical Procedures*
Anti-Bacterial Agents / therapeutic use
Cohort Studies
Elective Surgical Procedures*
Hand / surgery*
Humans
Immunocompromised Host
Patient Admission / statistics & numerical data*
Patient Compliance
Postoperative Complications / epidemiology*
Postoperative Complications / therapy
Reoperation / statistics & numerical data*
Retrospective Studies
Rhode Island / epidemiology
Risk Factors

Substances

Anti-Bacterial Agents