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

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

doi:10.1016/j.jhsa.2017.10.015

Cited by 17 publications

(20 citation statements)

References 35 publications

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“…Donato et al 13 conducted an analysis of ACS-NSQIP that found a similar reoperation rate of 33% following unplanned readmission. Goodman et al 12 reviewed complications following elective hand surgeries at a single institution and found that 16 of 27 patients with an unplanned 30-day admission also required a reoperation. Our analysis agrees with the finding that unanticipated admission is associated with increased risk of reoperation.…”

Section: Discussionmentioning

confidence: 99%

Unanticipated Admission Following Outpatient Ligament Reconstruction and Tendon Interposition: An Analysis of 3966 Cases

Hresko

Kleiner

Kosinski

et al. 2020

Hand (New York, N,Y.)

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Background: Hand surgeons in the United States commonly perform ligament reconstruction and tendon interposition (LRTI) to address debilitating thumb carpometacarpal arthritis. The objective of this investigation was to examine the characteristics that place patients at risk for unanticipated inpatient admission after a planned outpatient LRTI. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) datasets from years 2009 to 2016 were used to identify patients with a primary Current Procedural Terminology code for LRTI (25445, 25447). Only outpatient, nonemergent, and elective procedures were considered. Univariable and multivariable regression were used to determine risk factors and postoperative complications associated with increased likelihood of unanticipated admission, defined as length of initial hospital stay greater than 0 days. Statistical significance was set at P < .05. Results: Of 3966 patients who underwent outpatient LRTI, 134 (3.4%) had unplanned admission. On multivariable regression, age ≥ 65 years (odds ratio [OR] = 1.50), white race (OR = 4.44), and chronic steroid use (OR = 2.42) were significant predictors of unplanned admission. History of smoking, obesity, hypertension, diabetes, American Society of Anesthesiologists classification, and anesthesia method were not associated with admission. Patients who had unplanned admission had increased rate of reoperation (2.5% vs 0.3%) compared with nonadmitted patients. There was no difference in rate of postoperative infection, deep vein thrombosis, wound dehiscence, or 30-day mortality. Conclusions: Age ≥ 65 years, chronic steroid use, and white race were significant predictors of unplanned admission following LRTI. Identifying patients with these characteristics will be critical in risk adjusting the anticipated cost of the episode of care in outpatient LRTI.

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Section: Discussionmentioning

confidence: 99%

Unanticipated Admission Following Outpatient Ligament Reconstruction and Tendon Interposition: An Analysis of 3966 Cases

Hresko

Kleiner

Kosinski

et al. 2020

Hand (New York, N,Y.)

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“…8,9 Although small observational studies have been able to investigate the risks of some postoperative infections and nerve injuries, the risk and incidence of reoperation, and rarer complications such as deep infection, have been poorly defined because of limitations in coding systems, and the difficulty in enabling full longitudinal follow-up of patients over time within multiple private healthcare systems, especially those that do not link to official mortality records. [10][11][12][13] Increasingly, evidence from routinely collected data is used to evaluate health-care interventions in the general population. 14 Outcome data from real world practice enables improved counselling of patients both before referral by primary care physicians, and before surgery.…”

Section: Introductionmentioning

confidence: 99%

Serious postoperative complications and reoperation after carpal tunnel decompression surgery in England: a nationwide cohort analysis

Lane

Craig

Rees

et al. 2021

The Lancet Rheumatology

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Background Carpal tunnel decompression surgery to treat carpal tunnel syndrome is a common procedure, yet data on safety and effectiveness of the operation in the general population remain scarce. We aimed to estimate the incidence of reoperation and serious postoperative complications (requiring admission to hospital or further surgery) following carpal tunnel decompression in routine clinical practice and to identify the patient factors associated with these adverse outcomes. Methods We did a nationwide cohort analysis including all carpal tunnel decompression surgeries in patients aged 18 years or older, done in the National Health Service in England between April 1, 1998, and March 31, 2017, using the Hospital Episode Statistics dataset linked to mortality records. Patients were followed-up until death or until the end of the study (March 31, 2017). Primary outcomes were the overall incidence of carpal tunnel decompression reoperation and serious postoperative complications (surgical site infection or dehiscence, or neurovascular or tendon injury, requiring admission to hospital or further surgery) within 30 days and 90 days after surgery. Multivariable Cox regression analysis was used to identify factors influencing complications and reoperation, and the Fine and Gray method was used to adjust for the competing risk of mortality. This study is registered with ClinicalTrials.gov, NCT03573765. Findings 855 832 carpal tunnel decompression surgeries were done between April 1, 1998, and March 31, 2017 (incidence rate 1•10 per 1000 person-years [95% CI 1•02-1•17]). 29 288 procedures (3•42%) led to carpal tunnel decompression reoperation (incidence rate 3•18 per 1000 person-years [95% CI 3•12-3•23]). Of the 855 832 initial surgeries, 620 procedures (0•070% [95% CI 0•067-0•078]) led to a serious complication within 30 days after surgery, and 698 procedures (0•082% [0•076-0•088]) within 90 days. Local complications within 90 days after surgery were associated with male sex (adjusted hazard ratio 2•32 [95% CI 1•74-3•09]) and age category 18-29 years (2•25 [1•10-4•62]). Male sex (adjusted subhazard ratio 1•09 [95% CI 1•06-1•13]), old age (>80 years vs 50-59 years: 1•09 [1•03-1•15]), and greater levels of comorbidity (Charlson score ≥5 vs 0: 1•25 [1•19-1•32]) and socioeconomic deprivation (most deprived 10% vs least deprived 10%: 1•18 [1•10-1•27]) were associated with increased reoperation risk. Interpretation To our knowledge, this is the largest national study on carpal tunnel decompression to date, providing strong evidence on serious postoperative complication and reoperation rates. Carpal tunnel decompression appears to be a safe operation in most patients, with an overall serious complication rate (requiring admission to hospital or further surgery) of less than 0•1%.

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“…Previous studies that investigated surgical outcomes after DRF ORIF have not focused on readmissions. 8 9 10 Single institution studies are limited by a small sample size and limited generalizability, Goodman et al 11 studied 314 ORIFs with one unplanned revision surgery within 30 days of the procedure. Other studies have used state databases, which have the limitations inherent to administrative databases, 12 13 14 or have grouped hand and forearm diagnoses.…”

mentioning

confidence: 99%

“…Other studies have used state databases, which have the limitations inherent to administrative databases, 12 13 14 or have grouped hand and forearm diagnoses. 11 , 15 16 17 This makes it difficult to interpret the results, with some studies having over 300 procedural codes aggregated in a single analysis.…”

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confidence: 99%

Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients

Malpani¹,

John²,

Mercier³

et al. 2020

JAAOS Glob Res Rev

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Purpose: Distal radius fracture (DRF) open reduction and internal fixation (ORIF) is a common surgical procedure. This study assesses reasons and risk factors for readmission after DRF ORIF using the large sample size and follow-up of the American College of Surgeons National Surgical Quality Improvement Program database. Methods: Adult patients who underwent DRF ORIF were identified in the 2011 to 2016 National Surgical Quality Improvement Program database. Patient demographics, comorbidity status, hospital metrics, and 30-day perioperative outcomes were tabulated. Readmission, time to readmission, and reason for readmission were assessed. Reasons for readmission were categorized. Risk factors for readmission were assessed with multivariate analyses. Results: Of 11,124 patients who underwent DRF ORIF, 196 (1.76%) were readmitted within 30 days. Based on multivariate analysis, predictors of readmission ( P < 0.05) were as follows: American Society of Anesthesiologist class > 3 (Odds ratio [OR] = 2.87), functionally dependent status (OR = 2.25), diabetes with insulin use (OR = 1.97), and staying in hospital after the index surgery (inpatient procedure, OR = 2.04). Readmissions occurred at approximately 14 days postoperatively. Of the recorded reasons for readmission after DRF ORIF, approximately one quarter were for surgical reasons, whereas over 75% of readmissions were for medical reasons unrelated to the surgery. Conclusion: This study found the rate of 30-day unplanned readmissions after DRF ORIF to be 1.76%. Demographic, comorbid, and perioperative factors predictive of readmission were defined. Most postoperative readmissions were for medical reasons unrelated to the surgical site and occurred at an average of approximately 2 weeks postoperatively. Multivariate analysis found that patients with increased American Society of Anesthesiologist class > 3, functional dependence, insulin-dependent diabetes, and those who underwent inpatient surgery for any reason were at a greater risk for readmission. Understanding these factors may aid in patient counseling and quality improvement initiatives, and this information should be used for risk stratification and risk adjustment of quality measures.

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

Cited by 17 publications

References 35 publications

Unanticipated Admission Following Outpatient Ligament Reconstruction and Tendon Interposition: An Analysis of 3966 Cases

Unanticipated Admission Following Outpatient Ligament Reconstruction and Tendon Interposition: An Analysis of 3966 Cases

Serious postoperative complications and reoperation after carpal tunnel decompression surgery in England: a nationwide cohort analysis

Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients

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