Timing of Complications Following Hand Surgery
Nitin Goyal, MD, Daniel D. Bohl, MD, MPH and Robert W. Wysocki, MD, Rush University Medical Center, Chicago, IL
The incidence and corresponding risk factors for complications following several hand surgeries have been well described in the literature. Despite the well-studied incidence of adverse events following hand procedures, few studies have characterized the timing of complications. Our purpose was to characterize the timeline of eight postoperative complications following hand surgery, with stratification between outpatient and inpatient procedures.
Patients undergoing hand, wrist, and forearm procedures from 2005-2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Cases were stratified as to whether they were performed in an outpatient setting or inpatient setting. The following eight postoperative adverse events were analyzed: myocardial infarction, sepsis, pulmonary embolism, acute kidney injury, pneumonia, deep vein thrombosis, urinary tract infection, and surgical site infection. Timing of each adverse event was characterized by determining the median postoperative day of diagnosis along with the interquartile range and middle 80% to assess spread. Non-parametric Wilcoxon rank-sum tests were utilized to compare adverse event timing between inpatient and outpatient hand, wrist, and forearm surgery.
A total of 59,040 patients met inclusion criteria for this study. The median postoperative day of diagnosis (interquartile range) for each adverse event was as follows: myocardial infarction 1 (1-3), sepsis 1 (0-8), pulmonary embolism 2 (2-16), acute kidney injury 3 (1-13), pneumonia 6 (2-14), deep vein thrombosis 9 (3-21), urinary tract infection 13 (5-19), surgical site infection 14 (7-21) (Figure 1) Timing was statistically significantly earlier in inpatients compared to outpatients for sepsis (day 1 [interquartile range 0-4] versus day 15 [interquartile range 7-22], p<0.001), acute kidney injury (day 2 [interquartile range 1-7], versus day 14 [4-21], p=0.012), pneumonia (day 3.5 [1-10] versus day 14 [7-23], p=0.001), deep vein thrombosis (day 6 [3-12] versus day 21 [12-23], p=0.007), urinary tract infection (day 6 [0-16] versus day 15 [7.5-20.5], p=0.001), and surgical site infection (day 8 [0-16] versus day 15 [10-22], p<0.001) (Figure 2).
This study characterizes postoperative adverse event timing following hand surgery. Surgeons should have the lowest threshold for testing for each complication during the time period of greatest risk.
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