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Differences in Thirty-Day Morbidity and Mortality in Open and Arthroscopic Surgery of the Triangular Fibrocartilage Complex
Anthony P. Trenga, MD, James Willcockson, MD and Anthony J. LoGiudice, MD, Medical College of Wisconsin, Milwaukee, WI

Introduction
Open and arthroscopic techniques have been described for repair and debridement of the triangular fibrocartilage complex (TFCC), both with good results. We queried a national database to identify differences in 30-day outcomes and complications between the two techniques; We hypothesize that arthroscopic techniques will have shorter surgical time and will result in fewer complications and re-operations.

Materials & Methods
The NSQIP Database was queried from 2015-2018 for patients undergoing open (25107) or arthroscopic (29846) triangular fibrocartilage complex repair or debridement. Results returned 1006 arthroscopic procedures and 113 open procedures.

Results
Average operative time was 63.4 vs. 82.64 minutes for arthroscopic and open, respectively (p<.001); the majority of both were performed as an outpatient and so no differences in length of stay were observed. In the arthroscopic group there were 4 superficial infections, and no deep infections; In the open group there were no infections. There was no statistical significance in incidence of infection between groups.
There were no episodes of pulmonary embolus, stroke, cardiac arrest, myocardial infarction, post-operative transfusion, or deaths within 30 days in either groups. There was 1 instance of post-operative pneumonia in the open group (p<0.001). There was one instance of post-operative UTI, two instances of post-operative sepsis, two readmissions, and 2 re-operations in the arthroscopic group; there were none in the open group, however these differences were not statistically significant.

Conclusions
Open and arthroscopic approaches for debridement and repair of the TFCC are both very safe with few short-term complications. Our cohort was heavily skewed towards arthroscopic treatment, further underscoring its utility as the gold-standard for treatment of TFCC pathology. On average, arthroscopic surgery is significantly faster which should be taken into consideration in the context of patient suitability for the OR as well as resource utilization and cost.


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