McQuillan Thomas J, Hawkins Jessica E, Ladd Amy L
Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, CA.
Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, CA.
J Hand Surg Am. 2017 Sep;42(9):749.e1-749.e7. doi: 10.1016/j.jhsa.2017.05.011. Epub 2017 Jun 23.
Congenital hand differences are infrequent phenomena, and their treatment represents a relatively small fraction of cases performed by hand surgeons. Little is known about the incidence of wound complications and acute postoperative problems given the relative rarity of these procedures. This study sought to characterize the incidence of complications within 30 days of surgery for congenital hand differences.
The National Surgical Quality Improvement Program (NSQIP) contains prospective data regarding 30-day morbidity from 64 pediatric centers across the United States. Data from all available years (2012-2014) were queried for Current Procedural Terminology (CPT) codes pertinent to the treatment of congenital hand differences. Bivariate statistics, Fisher exact tests and Poisson 95% confidence intervals (95% CI) were used to assess the incidence of complications and examine risk factors for these outcomes.
We identified a total of 1,656 congenital hand cases that represented 4 different CPT codes, including surgery for simple syndactyly, complex syndactyly, and polydactyly. The overall incidence of complications was 2.2% (95% CI, 1.6%-3.1%; n = 37) with the most common complication being superficial surgical site infection (1.7%; 95% CI, 1.1%-2.4%) followed by related readmission (0.3%; 95% CI, 0.1%-0.7%). There was a higher incidence of complications observed in patients undergoing complex syndactyly repair (5.2% for complex syndactyly repair vs 2.3% for all others).
The rate of acute complications following procedures to correct syndactyly and polydactyly is low, the most common of which is superficial surgical site infection. The incidence of acute complications may be helpful in counseling patients and families. We suggest that further research must prioritize collecting data on long-term functional outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
先天性手部畸形是罕见现象，其治疗在手部外科医生所做的手术病例中占比相对较小。鉴于这些手术相对少见，关于伤口并发症和术后急性问题的发生率知之甚少。本研究旨在描述先天性手部畸形手术后30天内并发症的发生率。
国家外科质量改进计划（NSQIP）包含来自美国64个儿科中心的关于30天发病率的前瞻性数据。查询了所有可用年份（2012 - 2014年）与先天性手部畸形治疗相关的现行手术操作术语（CPT）编码数据。采用双变量统计、Fisher精确检验和泊松95%置信区间（95%CI）来评估并发症的发生率并检查这些结果的危险因素。
我们共识别出1656例先天性手部病例，代表4种不同的CPT编码，包括简单并指、复杂并指和多指畸形的手术。并发症的总体发生率为2.2%（95%CI，1.6% - 3.1%；n = 37），最常见的并发症是浅表手术部位感染（1.7%；95%CI，1.1% - 2.4%），其次是相关再入院（0.3%；95%CI，0.1% - 0.7%）。在接受复杂并指修复的患者中观察到的并发症发生率更高（复杂并指修复为5.2%，而其他所有情况为2.3%）。
矫正并指和多指畸形手术后的急性并发症发生率较低，其中最常见的是浅表手术部位感染。急性并发症的发生率可能有助于向患者和家属提供咨询。我们建议进一步的研究必须优先收集关于长期功能结果的数据。
研究类型/证据水平：治疗性II级。
