Stanford University School of Medicine.
From the Division of Plastic and Reconstructive Surgery, Department of Surgery.
Plast Reconstr Surg. 2023 Jul 1;152(1):109-115. doi: 10.1097/PRS.0000000000010144. Epub 2023 Jan 2.
This study assessed whether adding trigger finger or carpal tunnel release at the time of thumb carpometacarpal (CMC) arthroplasty would increase postoperative opioid use, readmissions, complications, or development of complex regional pain syndrome (CRPS).
Using the IBM MarketScan Research Databases from 2012 through 2016, the authors identified two CMC arthroplasty groups. The CMC-only group only had a CMC arthroplasty on the day of operation; the multiple-procedures group had a CMC arthroplasty and concurrent carpal tunnel or trigger finger release. Between the two groups, the authors compared persistent opioid use, 30-day readmissions, 30-day complications, and diagnosis of CRPS.
The CMC-only group consisted of 18,010 patients; the multiple-procedures group consisted of 4064 patients. The patients in the multiple-procedures group received a CMC arthroplasty and a carpal tunnel release (74%), a trigger finger release (20%), or both (6%). CMC-only patients had lower rates of persistent opioid use compared with patients who underwent multiple procedures (16% versus 18%). Readmission rates were also lower for CMC-only patients (3% versus 4%). CMC-only patients had decreased odds of persistent opioid use (OR, 0.85; 95% CI, 0.75 to 0.97; P = 0.013) and readmissions (OR, 0.80; 95% CI, 0.67 to 0.96; P = 0.016). The most common reason for readmission was pain (16%).
Adding another procedure to a CMC arthroplasty slightly increases the odds of adverse outcomes such as persistent opioid use and readmission. Patients and providers should weigh the efficiency of performing these procedures concurrently against the risk of performing multiple procedures at once.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究评估了在拇指腕掌（CMC）关节成形术时增加扳机指或腕管松解术是否会增加术后阿片类药物的使用、再入院、并发症或复杂性区域疼痛综合征（CRPS）的发展。
使用 IBM MarketScan 研究数据库（2012 年至 2016 年），作者确定了两个 CMC 关节成形术组。仅 CMC 组仅在手术当天进行 CMC 关节成形术；多程序组进行 CMC 关节成形术和同时行腕管松解或扳机指松解。在这两组之间，作者比较了持续性阿片类药物的使用、30 天再入院、30 天并发症和 CRPS 的诊断。
仅 CMC 组包括 18010 例患者；多程序组包括 4064 例患者。多程序组患者接受 CMC 关节成形术和腕管松解术（74%）、扳机指松解术（20%）或两者（6%）。与接受多程序治疗的患者相比，仅 CMC 患者的持续性阿片类药物使用率较低（16%比 18%）。再入院率也较低（3%比 4%）。与多程序组相比，仅 CMC 组患者持续性阿片类药物使用的可能性降低（OR，0.85；95%CI，0.75 至 0.97；P=0.013）和再入院的可能性降低（OR，0.80；95%CI，0.67 至 0.96；P=0.016）。再入院的最常见原因是疼痛（16%）。
在 CMC 关节成形术的基础上增加另一项手术会略微增加持续性阿片类药物使用和再入院等不良结局的可能性。患者和医生应该权衡同时进行这些手术的效率与一次进行多项手术的风险。
临床问题/证据水平：治疗性，III 级。
