Operative vs. Nonoperative Management of Flexor Tenosynovitis: An Analysis of the National Readmissions Database
Justin D Sawyer, MD1; Michael W Neumeister, MD2; Steven Scaife, MS3
1Institute For Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL; 2Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL; 3Southern Illinois University School of Medicine, Springfield, IL
Introduction Pyogenic flexor tenosynovitis (PFT) is a severe infection of the flexor tendon sheath in the digits of the hand. The condition can lead to debilitating outcomes or amputation if undertreated or diagnosed late. Current treatment strategies include nonoperative management with IV antibiotics, closed tendon sheath irrigation, and continuous postoperative irrigation, yet there is no consensus regarding when non-operative treatment is appropriate. We have used the National Readmissions Database, Healthcare Cost and Utilization Project (HCUP) to characterize the readmission patterns of patients diagnosed with PFT and compare the outcomes of operative and nonoperative management.
Materials and Methods ICD-10 codes were used to identify patients admitted with PFT from 2016-2019. We identified the baseline comorbidities and characteristics using the National Readmissions Database, Healthcare Cost and Utilization Project (HCUP). We then identified the top ten diagnoses of 90-day readmissions. A multivariate regression analysis was then performed to identify factors associated with 90-day readmissions. Patients were then separated into two groups: those that underwent drainage of the flexor tendon sheath vs. those who did not undergo operative intervention based on ICD-10 PCS procedure codes. Baseline characteristics between the two groups were then compared, and 90-day readmission rate, amputation rate, and length of stay were then determined amongst the two groups.
Results We identified a weighted count of 16,596 cases of PFT. The overall 90-day readmissions rate was 13.25% for all comers. 9/10 of the leading diagnoses associated with readmission were infectious sequelae. The variables associated with 90-day readmission on multivariate regression analysis were higher Charlson Comorbidity Index (OR=1.28, (1.226-1.336), hypertension (OR=1.348 (1.149-1.580)), Medicaid vs. private insurance payer (OR=0.614 (0.486-0.777)), longer initial length of hospital stay (OR-1.041 (1.028-1.055)), and lack of operative intervention (OR=0.833 (0.716-0.970)). 90-day readmission rate (3.71% vs 9.58%, p = 0.0002) and amputation rate (1.12% vs 3.71%, p <.0001) were significantly higher in the nonoperative group.
Conclusions Operative intervention led to fewer hospital readmissions and fewer amputations. In addition, worse baseline comorbidities (higher Charlson Index), and Medicaid vs. private insurance were associated with greater likelihood for 90-day readmission.
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