Impact of Adding Carpal Tunnel Release or Trigger Finger Release to Carpometacarpal Arthroplasty on Postoperative Complications”

Abstract

Background: This study assessed whether adding trigger finger or carpal tunnel release at the time of thumb carpometacarpal (CMC) arthroplasty would increase postoperative opioid use, readmissions, complications, or development of complex regional pain syndrome (CRPS). Methods: Using the IBM MarketScan Research Databases from 2012 through 2016, the authors identified two CMC arthroplasty groups. The CMC-only group only had a CMC arthroplasty on the day of operation; the multiple-procedures group had a CMC arthroplasty and concurrent carpal tunnel or trigger finger release. Between the two groups, the authors compared persistent opioid use, 30-day readmissions, 30-day complications, and diagnosis of CRPS. Results: The CMC-only group consisted of 18,010 patients; the multiple-procedures group consisted of 4064 patients. The patients in the multiple-procedures group received a CMC arthroplasty and a carpal tunnel release (74%), a trigger finger release (20%), or both (6%). CMC-only patients had lower rates of persistent opioid use compared with patients who underwent multiple procedures (16% versus 18%). Readmission rates were also lower for CMC-only patients (3% versus 4%). CMC-only patients had decreased odds of persistent opioid use (OR, 0.85; 95% CI, 0.75 to 0.97; P = 0.013) and readmissions (OR, 0.80; 95% CI, 0.67 to 0.96; P = 0.016). The most common reason for readmission was pain (16%). Conclusions: Adding another procedure to a CMC arthroplasty slightly increases the odds of adverse outcomes such as persistent opioid use and readmission. Patients and providers should weigh the efficiency of performing these procedures concurrently against the risk of performing multiple procedures at once. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The impact of surgical elective exposure during medical school upon residency match rates

“…This challenge, combined with the ever-increasing competitiveness of successfully matching into surgical subspecialties, creates a barrier for students who attend schools that lack elective exposure opportunities. Previous studies have demonstrated that early exposure, lifestyle expectations, length of training, and role models significantly influence specialty choice [ [5] , [6] , [7] , [8] , [9] ]. Prior studies have also found that simulation and surgical skills trainers, as well as surgical electives during the preclinical years, may promote interest in the surgical field, further underscoring the value of specialty exposure upon residency selection [ 4 , 5 , 10 , 11 ].…”