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Incidence of Serious Complications in Hand Surgery: A 10-Year Review
Avi D Goodman, MD; Joseph A Gil, MD; Edward Akelman, MD; Arnold Peter C Weiss, MD
Alpert Medical School of Brown University / Rhode Island Hospital, Providence, RI

Purpose
While the rate of serious complications following hand surgery has been assumed to be low, the unplanned readmission and/or reoperation rate for the most common procedures has not been well described. The goal of this study was to calculate the incidence and identify the risk factors associated with these complications in a high-volume academic practice.

Methods
Our institution's Quality Assurance (QA) database was retrospectively examined for all serious complications (unplanned readmission and/or reoperation within 30 days) for two senior attending hand surgeons from February 2006 January 2016. Our cohort included only adults undergoing elective procedures. Each event was categorized by causative factor, and charts were reviewed to establish infection risk factors and cultured organisms. Our billing database was examined for the number of procedures performed over the same time period.

Results
Our cohort consisted of 18,081 surgeries, in which 27 serious complications occurred (0.15% total incidence; examples include: carpal tunnel release 0.10%, trigger digit release 0.09%, major wrist surgery 0.74%). There were 17 total infections (0.09% incidence). The complications were unevenly distributed with respect to time with eight (29.6%) occurring within seven days, 16 (59.2%) in 8-14 days, three (11.1%) in 15-21 days, and none in 22-30 days.

Conclusion
Complications after hand surgery requiring unplanned readmission and/or reoperation are infrequent, occurring at a rate of 15 per 10,000 cases, and varies based on the type of procedure performed. Infections were responsible for 40.7% of unplanned readmissions and/or reoperations, and 56.3% occurred in patients with an underlying risk factor. Although elective hand surgery is safely performed at high volumes, serious complications do rarely occur. More invasive and longer surgeries are associated with a higher incidence than other procedures, and these serious complications are most likely to occur within three weeks after surgery.




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