Patient Risk Factors Associated with Postoperative Complications after Hand Procedures
Kathleen A Marsh, BS1, Bryant Benjamin, MD1, Ian R Smithson, MD2, Michael D Wigton, MD2, Tianyi David Luo, MD3, Linda H Chao, MD4 and Ethan R Wiesler, MD5, (1)Wake Forest School of Medicine, Winston-Salem, NC, (2)Wake Forest Baptist Medical Center, Winston Salem, NC, (3)WAKE FOREST UNIVERSITY, WINSTON SALEM, NC, (4)Wake Forest Baptist Health, Winston-Salem, NC, (5)Wake Forest University Baptist Medical Center, Winston-Salem, NC
1. INTRODUCTION
Carpal tunnel syndrome (CTS), trigger finger (TF), and De Quervain's tenosynovitis (DQ) are three common pathologies of the hand often treated with relatively simple surgical procedures. However, outcomes from these procedures can be compromised by postoperative complications. The aim of the current study was to evaluate the association between diabetes, tobacco use, and obesity and the incidence of postoperative complications.
2. METHODS
We reviewed 597 patients treated surgically for CTS, TF, or DQ from 2010 to 2015. We used bivariate and multivariate analyses to assess independent association between diabetes, tobacco use, obesity, and surgical complications and compared the incidences to healthier parients without these comorbidities. We also looked at patients with overlapping diagnoses of these comorbidities.
3. RESULTS
Bivariate analysis showed that diabetic patients and smokers were more likely to have a surgical complication. Multivariate analysis showed diabetes and tobacco use as independent predictors of complications. The disease states or combinations placing patients at the highest risk of a postoperative complication were the diabetic-smoker-obese, diabetic-smoker, diabetic-obese, diabetic, and smoker-obese groups. The diabetic-smoker-obese patient population had a 42.02% predicted rate of postoperative complications.
4. DISCUSSION and CONCLUSION
Diabetes and tobacco use are independent risk factors for complications after operative treatment of CTS, TF, and DQ. Obesity when co-existing with DM and/or tobacco use increased the risk of complications. When the three patient factors evaluated, DM, obesity, and tobacco use were all present the rate of complications was 42.02%. Careful assessment and discussion should occur prior to proceeding with operative treatment for simple hand conditions in patients with the highest risk factors studied.
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