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Patient, Injury, and Surgery-Specific Factors Influence Outcomes Following Flexor Tendon Repair
Richard Lander, MD
1, Andrew Rodenhouse, MD
1, Akhil Dondapati, MD
1, Gilbert Smolyak, BS
1, Thomas J Carroll, MD
1, Giap Vu, MD
1, Gabriel Ramirez, MS
1, Alayna E. Loiselle, PhD
2; Constantinos Ketonis, MD, PhD
1(1)University of Rochester Medical Center, Rochester, NY, (2)University of Rochester, Rochester, NY
BackgroundFlexor tendon lacerations are significant injuries with unacceptably high complication rates after repair. There is a paucity of literature on factors that predict outcomes as experienced by the patients, namely patient-reported outcome measures (PROMs). The purpose of this study was to elucidate the factors affecting outcomes and complications following flexor tendon repair. We hypothesized that multiple patient-specific, injury-specific, and surgery-specific factors would independently affect PROMIS scores and complication rates.
MethodsThis retrospective study included patients aged ?18 who underwent primary flexor tendon repair from January 1, 2015, to October 1, 2023. Outcomes analyzed were return to the operating room (RTOR), time to RTOR, discharge from hand therapy, return to work, and PROMIS scores (Physical Function [PF], Pain Interference [PI], Depression, and Upper Extremity [UE]). Statistical models included logistic, negative binomial, and linear regression.
ResultsIn total, 397 patients with 523 injured digits were identified for analysis. Average age of the study population was 39.7 years (SD: 16.1) with 281 (70.8%) patients being male. Laceration-type mechanism was most common (74.8%), followed by sawblade (18.1%) and crush (4.5%) injury.
Advanced age, sex, race, body mass index, insurance type, area of deprivation index were patient-specific factors that influenced outcomes. Patients aged 30-49 had worse PROMIS scores at 6 and 12 weeks. Males reported lower depression scores but were less compliant postoperatively. Black/African American patients experienced higher PI and depression scores compared to White patients. Overweight patients had better early PF scores and returned to work sooner. Medicaid insurance was linked to worse scores across PI, depression, and UE domains.
The mechanism of injury and involvement of single or multiply injured digits were injury-specific variables that influenced outcomes. Saw blade injuries increased compliance and time to return to work but were associated with higher depression and lower PF at 12 weeks. Patients with multiple injured digits required more therapy time.
Surgeon experience and time to surgery were the surgery-specific factors predictive of outcomes. Surgeons with ?15 years of experience were linked to earlier return to work. Delayed surgery was associated with higher PF scores at 6 weeks. Surgeon specialty or hand fellowship training did not significantly influence outcomes.
ConclusionPatient, injury, and surgical factors significantly influenced complications and PROMIS outcomes following flexor tendon repair. These findings may help clinicians better counsel patients regarding recovery expectations.
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