Hand Surgery Outcomes In Orthopedic And Plastic SurgeryA. Peymani1,2, A.S. Dowlatshahi2, Z. Fullerton2, M. Malyar2, A.D. Chen2, S.J. Lin2

(1) Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands (2) Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Background

Both orthopedic surgeons and plastic surgeons operate on the hand. There are extensive differences in training, scope of practice, and clinical spectrum of patients when comparing residency training programs. Comparable studies have shown significant differences in outcomes of other specialties.

The aim of this study was to compare outcomes after surgical procedures of the hand, between orthopedic surgeons and plastic surgeons.

Methods

A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between 2005-2016, identifying all patients undergoing hand surgery. Current Procedural Terminology codes were used to categorize procedures into three groups: fracture repair, tendon repair, and amputation.

Post-operative complications, operating time, and length of hospital stay were analyzed and compared.

Results

A total of 16,448 cases were identified. Of these, 10,456 were operated upon by orthopedic surgeons and 5,992 were operated upon by plastic surgeons.

Plastic surgeons had higher operative times in amputation procedures, but lower operative times in fracture repair and tendinoplasty procedures. Post-operative complication rates were slightly higher in fracture repair by plastic surgeons, mainly driven by wound complications.

Conclusion

This study shows similar outcomes after tendinoplasty, fracture repair, and amputation when comparing orthopedic and plastic surgery.

Future outcome comparison studies should investigate other anatomical regions and procedures for which overlap of services exists.

Fracture RepairOrthopedic Surgery (n=920) Plastic Surgery (n=559) P

Complications 62 (1.2%) 50 (1.9%) 0.019

Wound 51 (1.0%) 44 (1.7%) 0.013

Infectious 2 (0.0%) 1 (0.0%) 0.980

Cardiovascular 0 (0.0%) 0 (0.0%) -

Neurologic 2 (0.0%) 0 (0.0%) 0.981

Pulmonary 2 (0.0%) 1 (0.0%) 0.938

Renal 4 (0.1%) 1 (0.0%) 0.287

Thromboembolic 1 (0.0%) 0 (0.0%) 0.983

Length of Stay, days 0.3 ± 5.3 0.3 ± 4.2 0.691

Operating Time, minutes 57.0 ± 38.8 54.6 ± 37.4 0.001

Tendon RepairOrthopedic Surgery (n=920) Plastic Surgery (n=559) P

Complications 77 (1.8%) 70 (2.5%) 0.111

Wound 62 (1.5%) 59 (2.1%) 0.108

Infectious 3 (0.1%) 1 (0.0%) 0.630

Cardiovascular 1 (0.0%) 3 (0.1%) 0.132

Neurologic 1 (0.0%) 1 (0.0%) 0.696

Pulmonary 3 (0.1%) 2 (0.1%) 0.828

Renal 5 (0.1%) 5 (0.2%) 0.282

Thromboembolic 0 (0.0%) 1 (0.0%) 0.971

Length of Stay, days 0.2 ± 1.6 0.3 ± 2.0 0.621

Operating Time, minutes 67.1 ± 52.3 69.0 ± 51.4 0.045

AmputationOrthopedic Surgery (n=920) Plastic Surgery (n=559) P

Complications 78 (8.5%) 50 (8.9%) 0.550

Wound 44 (4.8%) 27 (4.8%) 0.549

Infectious 14 (1.5%) 14 (2.5%) 0.787

Cardiovascular 5 (0.5%) 3 (0.5%) 0.635

Neurologic 1 (0.1%) 0 (0.0%) 0.999

Pulmonary 10 (1.1%) 7 (1.3%) 0.914

Renal 6 (0.7%) 5 (0.9%) 0.784

Thromboembolic 0 (0.0%) 4 (0.7%) 0.985

Length of Stay, days 1.8 ± 5.5 2.8 ± 7.1 0.055

Operating Time, minutes 39.5 ± 29.1 46.1 ± 40.7 0.002