gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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What factors influence the need for revision surgery? A 19-year longitudinal cohort study of 855,832 carpal tunnel decompression surgeries in England

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  • presenting/speaker Jennifer Lane - University of Oxford, NDORMS, Botnar Research Centre, Oxford, United Kingdom
  • Richard Craig - University of Oxford, NDORMS, Botnar Research Centre, Oxford, United Kingdom
  • Jane Green - University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
  • Daniel Prieto-Alhambra - University of Oxford, NDORMS, Botnar Research Centre, Oxford, United Kingdom
  • Dominic Furniss - University of Oxford, NDORMS, Botnar Research Centre, Oxford, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-658

doi: 10.3205/19ifssh0718, urn:nbn:de:0183-19ifssh07188

Published: February 6, 2020

© 2020 Lane et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The aim of this study was to use a routinely collected data generated in the NHS in England to identify the incidence of revision CTD surgery, and the patient factors associated with revision. The secondary aim was to identify the rate of other complications following CTD surgery.

Methods: Validated procedure codes (OPCS codes) were prospectively collected as part of routine care were used to identify primary and revision CTDs in adults from April 1998-2017. Disease status was defined by ICD-10 code. Patients were followed up until death or April 2017. Where possible, episodes were linked for those who had undergone both primary and revision CTD to calculate time to revision. Cox regression analyses were used to identify factors influencing revision.

Secondary complications studied included trigger finger, tenosynovitis, wound dehiscence, wound infection, tendon injury and median nerve/ vascular injury.

Results and Conclusions: 855, 832 primary CTDs were undertaken, 68% in women, with a significant peak in surgeries undertaken in women between 45-60 years of age. 29,288 (3.4%) of patients underwent revision CTD in the 19 year period; 18,737 primary CTDs were linked with a revision on the same hand. The median time to revision was 351 days (IQR 144 to 966). Time to revision was significantly influenced by male gender, increasing age and a past medical history of diabetes. The overall rate of complications in the first 30 days after surgery was 0.05% and 0.34% for complications occurring at any time following surgery.

Using real world data over 19 years, the incidence of revision CTD in England was 3.18 per 1000 person years. A history of diabetes, increasing age and male gender were significant factors in revision. Over 50% of patients that undergo revision do so within one year of primary surgery and the overall complication rate is very low.