Hand Surgery Outcomes In Orthopedic And Plastic...
Transcript of Hand Surgery Outcomes In Orthopedic And Plastic...
Hand Surgery Outcomes In Orthopedic And Plastic SurgeryA. Peymani1,2, A.S. Dowlatshahi2, Z. Fullerton2, M. Malyar2, A.D. Chen2, S.J. Lin2
(1) Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands (2) Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Background
Both orthopedic surgeons and plastic surgeons operate on the hand. There are extensive differences in training, scope of practice, and clinical spectrum of patients when comparing residency training programs. Comparable studies have shown significant differences in outcomes of other specialties.
The aim of this study was to compare outcomes after surgical procedures of the hand, between orthopedic surgeons and plastic surgeons.
Methods
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between 2005-2016, identifying all patients undergoing hand surgery. Current Procedural Terminology codes were used to categorize procedures into three groups: fracture repair, tendon repair, and amputation.
Post-operative complications, operating time, and length of hospital stay were analyzed and compared.
Results
A total of 16,448 cases were identified. Of these, 10,456 were operated upon by orthopedic surgeons and 5,992 were operated upon by plastic surgeons.
Plastic surgeons had higher operative times in amputation procedures, but lower operative times in fracture repair and tendinoplasty procedures. Post-operative complication rates were slightly higher in fracture repair by plastic surgeons, mainly driven by wound complications.
Conclusion
This study shows similar outcomes after tendinoplasty, fracture repair, and amputation when comparing orthopedic and plastic surgery.
Future outcome comparison studies should investigate other anatomical regions and procedures for which overlap of services exists.
Fracture RepairOrthopedic Surgery (n=920) Plastic Surgery (n=559) P
Complications 62 (1.2%) 50 (1.9%) 0.019
Wound 51 (1.0%) 44 (1.7%) 0.013
Infectious 2 (0.0%) 1 (0.0%) 0.980
Cardiovascular 0 (0.0%) 0 (0.0%) -
Neurologic 2 (0.0%) 0 (0.0%) 0.981
Pulmonary 2 (0.0%) 1 (0.0%) 0.938
Renal 4 (0.1%) 1 (0.0%) 0.287
Thromboembolic 1 (0.0%) 0 (0.0%) 0.983
Length of Stay, days 0.3 ± 5.3 0.3 ± 4.2 0.691
Operating Time, minutes 57.0 ± 38.8 54.6 ± 37.4 0.001
Tendon RepairOrthopedic Surgery (n=920) Plastic Surgery (n=559) P
Complications 77 (1.8%) 70 (2.5%) 0.111
Wound 62 (1.5%) 59 (2.1%) 0.108
Infectious 3 (0.1%) 1 (0.0%) 0.630
Cardiovascular 1 (0.0%) 3 (0.1%) 0.132
Neurologic 1 (0.0%) 1 (0.0%) 0.696
Pulmonary 3 (0.1%) 2 (0.1%) 0.828
Renal 5 (0.1%) 5 (0.2%) 0.282
Thromboembolic 0 (0.0%) 1 (0.0%) 0.971
Length of Stay, days 0.2 ± 1.6 0.3 ± 2.0 0.621
Operating Time, minutes 67.1 ± 52.3 69.0 ± 51.4 0.045
AmputationOrthopedic Surgery (n=920) Plastic Surgery (n=559) P
Complications 78 (8.5%) 50 (8.9%) 0.550
Wound 44 (4.8%) 27 (4.8%) 0.549
Infectious 14 (1.5%) 14 (2.5%) 0.787
Cardiovascular 5 (0.5%) 3 (0.5%) 0.635
Neurologic 1 (0.1%) 0 (0.0%) 0.999
Pulmonary 10 (1.1%) 7 (1.3%) 0.914
Renal 6 (0.7%) 5 (0.9%) 0.784
Thromboembolic 0 (0.0%) 4 (0.7%) 0.985
Length of Stay, days 1.8 ± 5.5 2.8 ± 7.1 0.055
Operating Time, minutes 39.5 ± 29.1 46.1 ± 40.7 0.002