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Hand Surgery Outcomes In Orthopedic And Plastic Surgery A. Peymani 1,2 , A.S. Dowlatshahi 2 , Z. Fullerton 2 , M. Malyar 2 , A.D. Chen 2 , S.J. Lin 2 (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 Repair Orthopedic 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 Repair Orthopedic 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 Amputation Orthopedic 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
