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American Association for Hand Surgery

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Unplanned Office Visits Following Outpatient Hand Surgery
Clay Townsend, MD, Rothman Institute at Thomas Jefferson University Hopsital, Philadelphia, PA, Tyler W. Henry, MD, Sidney Kimmel Medical College at Jefferson University, Philadelphia, PA, Kevin F Lutsky, MD, Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA and Pedro K Beredjiklian, M.D., Rothman Institute, Philadelphia, PA

Introduction
Patients returning to the office for an unplanned visit postoperatively can be burdensome to both the patient and provider. The purpose of this study was to quantify the rate of unplanned office visits after common soft tissue hand surgeries and assess the reasons for these unplanned visits.
Materials and Methods
Institutional Review Board approval was obtained prior to initiation of this study. Patients who underwent common soft tissue hand surgeries (trigger finger release [CPT Codes: 26145, 26055], open carpal tunnel release [CPT Code: 64721], endoscopic carpal tunnel release [CPT Code: 29848], and De Quervain's release [CPT Code: 25000]) performed by a fellowship trained orthopaedic hand surgeon over a 6 month time period were queried from an electronic medical record database. Manual chart review was performed to record patient demographics, unplanned visits within 3 months postoperatively, and specific reasons for unplanned visits. A student's t test was utilized to compare continuous variables between groups, and a Chi square test was utilized to compare the differences in categorical variables between groups. Statistical significance was set at p < .05.
Results
There were 1224 surgeries performed, and there were 1648 total postoperative follow up visits included in analysis. Eighty-two patients (6.7%) had an unplanned office visit postoperatively. These 82 patients had a total of 103 unplanned office visits within 3 months of surgery, representing 6.3% of all postoperative office visits. There was no difference in the rate of unplanned visits between the included surgeries (p=.46). The most common reasons for an unplanned office visit overall were wound problems (34%), pain (23.3%), and stiffness (17.5%). The trigger finger release group had significantly more patients have unplanned visits for stiffness (p=.01), the De Quervain's release group had significantly more patients return for pain (p=.02), and the carpal tunnel release group had significantly more patients return for persistent symptoms (p<.05).
Conclusions
Unplanned office visits represented about 1 of 16 (6.3%) postoperative visits. Orthopaedic surgeons should be aware of the most common reasons for these visits and be prepared to address these problems promptly. Preoperative patient education on these potential problems may help decrease the frequency of unplanned follow up visits.


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