Methods: Using the PearlDiver Mariner claims database (2010-2023), we identified adult patients who underwent carpal tunnel release, carpometacarpal joint arthroplasty, flexor tendon repair, extensor tendon repair, or trigger finger release. Patients were stratified by dialysis status. Complications, including infection, hematoma, delayed wound healing, and revision surgery, were assessed at 30 days, 90 days, and one year postoperatively. Groups were matched by age, sex, smoking status, obesity, and diabetes. Chi-square analysis and logistic regression were used to compare complication rates. Heatmaps and forest plots were used to visualize risk differences and odds ratios.
Results: Dialysis-dependent patients experienced significantly higher complication rates across nearly all procedure types. After carpal tunnel release, the overall complication rate in dialysis patients was 19.7% compared to 7.5% in non-dialysis patients (p < 0.001), driven by higher rates of infection (14.4% vs. 5.7%) and hematoma (2.0% vs. 0.5%). Flexor tendon repair showed the highest complication rate among dialysis patients at 32.2% versus 8.5% in non-dialysis patients (p = 0.001), primarily due to early hematoma formation. Patients undergoing carpometacarpal joint arthroplasty experienced more complications overall if on dialysis (17.7% vs. 8.9%, p = 0.011), with significantly higher infection and hematoma rates at early time points. Extensor tendon repair was also associated with increased complications in dialysis patients (26.0% vs. 14.6%, p = 0.012), including hematoma and revision surgery. Among patients undergoing trigger finger release, dialysis was associated with higher complication rates at all postoperative intervals (18.9% vs. 9.7%, p < 0.001), including elevated infection (15.5% vs. 7.9%), hematoma, and revision rates. Logistic regression confirmed higher odds of postoperative complications in dialysis patients, particularly after flexor tendon repair (odds ratio 6.77), carpal tunnel release (odds ratio 3.33), and extensor tendon repair (odds ratio 3.21). Despite this, rates of delayed wound healing and revision surgery were largely comparable between groups for most procedures.
Conclusions: Dialysis dependence is associated with significantly increased risk of postoperative complications following routine hand surgery, particularly infections and hematomas. The risk is most pronounced following tendon repairs and carpal tunnel release. These findings underscore the need for careful surgical planning, perioperative optimization, and postoperative vigilance in dialysis-dependent patients.
