Risk Factors and Reasons for Emergency Department Visits Within 30 Days of Elective Hand Surgery: An Analysis of 3,261 Patients.

Background: The frequency of hand and elbow surgeries occurring in outpatient and elective settings is on the rise. Emergency department (ED) visits in the postoperative period are increasingly used as quality measures for surgical care. The aim of this study is to determine the number of postoperative ED visits, the primary reason for these visits, and to identify risk factors associated with these visits. Methods: We examined all elective hand and elbow procedures performed at two hospitals within a single healthcare network between 2008 and 2017. A total of 3,261 patients met the study criteria. Descriptive statistics were calculated for our population, followed by univariate and multivariate analyses, to identify risk and protective factors associated with ED visits in the first 30 days after surgery. Results: Eighty-seven of 3,261 patients presented to the ED within 30 days of their operation (2.7%). The most common reasons for ED visits were related to pain (28.7%), swelling (26.4%), and concerns for infection (20.7%). Univariate analysis indicated history of drug use, number of procedures, smoking history, and serum albumin <3.5 mg/dL as risk factors for returns to the ED. Multivariate analysis identified history of drug use, number of procedures, and serum albumin <3.5 mg/dL as independent risk factors. Smoking history failed to achieve statistical significance as an independent risk factor. Both univariate and multivariate analyses identified age >60 years as protective for postoperative ED visits. Conclusions: ED visits within the first 30 days after elective hand surgery are relatively common, despite remarkably low complication rates among these procedures. This information may help to improve risk stratification in these patients, and to aid in the development of enhanced postoperative follow-up strategies to reduce unnecessary utilization of emergency medical services. Level of Evidence: Level III (Therapeutic).

Patient-Related Risk Factors Associated With Surgical Site Complications After Elective Hand Surgery.

BACKGROUND: The purpose of this study was to identify independent risk factors associated with an increased rate of surgical site complications after elective hand surgery. METHODS: This study is a retrospective review of all patients who underwent elective hand, wrist, forearm, and elbow surgery over a 10-year period at a single institution. Electronic medical records were reviewed, and information regarding patient demographics, past medical and social history, perioperative laboratory values, procedures performed, and surgical complications was collected. Surgical site complications included surgical site infections, seromas or hematomas, and delayed wound healing or wound dehiscence. A univariate analysis was then performed to identify potential risk factors, which were then included in a multivariate regression analysis. RESULTS: A total of 3261 patients who underwent elective hand surgery and met the above inclusion and exclusion criteria were included in this study. The mean age was 57 years, with 65% female and 35% male patients. The overall surgical complication rate was 2.2%. Univariate analysis of patient factors identified male sex; number of procedures >1; history of drug, alcohol, or smoking use; American Society of Anesthesiologists (ASA) class III and IV; and serum albumin <3.5 mg/dL to be significantly associated with complications. However, multivariate regression analysis identified that only ASA class III and IV (odds ratio = 3.27) was significantly associated with surgical complications. CONCLUSIONS: Patients classified as ASA class III or IV were identified to be at a significantly increased risk of complications following elective hand surgery. Health factors which triage patients into these 2 groups may represent potentially modifiable factors to mitigate perioperative risk in the elective hand surgery population.

Effect of Diabetes and Hemoglobin A1c on Complications Following Elective Hand Surgery.

Background: Limited research exists investigating the association between diabetes and glycemic control on complications following elective hand surgery. The goal of this research was to assess the incidence of complications within 30 days of elective hand surgery in a large population of diabetic patients compared to a population of non-diabetics. Furthermore, we sought to examine the relationship of glycemic control, as measured by HbA1c, and postoperative complications. Methods: We performed a retrospective review of electronic medical records at our institution of all patients who underwent elective hand, forearm, or elbow surgery from the dates of January 1st, 2008 to December 31st, 2017. Patients were categorized as diabetic or non-diabetic and most recent HbA1c was documented. Multivariable analysis was employed to compare the incidence of surgical complications within 30 days between the diabetics and non-diabetic populations, adjusting for baseline patient characteristics. Results: A total of 3,261 patients met the inclusion criteria. There were 646 (20%) diabetic patients and 2,615 (80%) non-diabetic patients. No difference was found in the overall rate of complications between the cohort of diabetic and non-diabetic patients. Additionally, statistical analysis found no difference in the complication rate between insulin and non-insulin controlled diabetics. Rates of complications were stratified based on HbA1c level and statistical analysis found no increased risk of complications with increased hemoglobin A1c value. Conclusions: In our present study we were not able to demonstrate any significant difference in the 30 day complication rates between and non-diabetics undergoing elective hand surgery. This study attempted to aid in risk stratification of diabetic patients by evaluating preoperative glycemic indices in the form of HbA1c.