Patients Using the 2006-2011 ACS-NSQIP Datasets
Angelo B. Lipira, MD; Philip D. Tatman, BS; Jason H. Ko, MD
Plastic Surgery, University of Washington, Seattle, WA
Introduction: The ACS-NSQIP database collects detailed and validated data on patient demographics, co-morbidities, and 30-day postoperative outcomes on patients undergoing operations in most subspecialties. This dataset has been previously used to delineate specific complication risks and risk factors in a number of surgical subspecialties, but has not yet been used for hand surgery. While the risk of early complications following hand surgery is generally believed to be low, it is important to define these risks quantitatively, and to identify patient groups who are at higher risk for complications so that preventive measures can be employed.
Materials and Methods: ACS-NSQIP data from 2006-2011 was queried using 293 hand-specific CPT codes. Descriptive statistics were calculated for the population, and potential risk factors and patient characteristics contained within the NSQIP database were analyzed for their association with complications in the 30-day postoperative period. The most common complications were identified, and significantly associated variables were determined.
Results: 204 hand-specific CPTs were represented in the data. Of these, 81 resulted in at least one complication. The overall 30-day complication rate for hand surgery was 2.7%. Women had fewer complications than men, and there were significant differences between races. Age and BMI did not correlate significantly with complication rates. Significant increase in complication rates were associated with insulin-dependent diabetes (10%), pre-operative dyspnea (5.4%), COPD (7.4%), hypertension (4.2%), peripheral vascular disease (14.9%), renal failure (44.1%), preoperative steroid use (10.5%), bleeding disorder (16.7%) and emergent surgery (10%). Increased surgical wound class was associated with increased rate of complications. Lower complication rates were associated with operations done under local or regional anesthesia. Decreased operating time and anesthesia time were significantly associated with decreased rate of complications. The most common complications were superficial and deep surgical site infections, urinary tract infection, unplanned intubation, sepsis, pneumonia, and wound disruption.
Conclusions: This study utilized a large, prospective national database to characterize the 30-day complication profile and risk factors for surgery of the hand. Overall, the incidence of complications is low, approximately 2.7%. However, rates are significantly elevated in certain sub-groups and with some perioperative conditions. The most common complications are listed and quantified. This information is valuable in counseling patients preoperatively, and in identifying groups of patients on whom risk reduction efforts should be focused.
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