Plastic Surgery Research Council

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Hand Surgery Outcomes In Orthopedic And Plastic Surgery
Abbas Peymani, MD MS, Samandar Dowlatshahi, MD, Austin Chen, None, Sabine Egeler, MD, Anna-Rose Johnson, BA MPH, Samuel Lin, MD MBA FACS.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

PURPOSE: Both plastic surgeons and orthopedic surgeons operate on the hand. Significant differences in training and patient volume remain across these services. Comparable studies have shown significant differences in outcomes of other specialties. The aim of this study is to compare outcomes after surgical procedures of the hand.
METHODS: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between 2005-2015, identifying all patients undergoing hand surgery. Current Procedural Terminology codes were used to categorize procedures into three groups: tendinoplasty, fracture repair, and amputation. Patient characteristics, operating time, length of hospital stay, and complications were analyzed.
RESULTS: A total of 8723 hand procedures were identified, 5277 performed by orthopedic surgeons and 3446 by plastic surgeons. Total hospital length of stay after tendinoplasty and fracture repair was significantly lower for orthopedic surgery. After covariate adjustment, there were no significant differences in operative time, wound complications, unplanned readmissions, and unplanned reoperations.
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.

Table 1. Study Characteristics
Specialty:
 Orthopedics

(n=5277)
Specialty: Plastic Surgery

(n=3446)
P-value
Women1579 (29.9%)1003 (29.1%)0.429
Age, y42.1 17.342.4 16.80.455
BMI28.7 6.428.5 6.30.225
Smoking1640 (31.1%)1053 (30.6%)0.619
Alcohol use52 (4.9%)60 (5.2%)0.771
Hypertension1115 (21.1%)649 (18.8%)0.010
Diabetes442 (8.4%)270 (7.8%)0.379
Race
- White
- Black
- Hispanic
- Asian
- Other
3596 (80.9%)
547 (12.3%)
12 (0.3%)
154 (3.5%)
135 (3.0%)
1627 (77.6%)
372 (17.7%)
22 (1.0%)
66 (3.1%)
11 (0.5%)
<0.001
ASA classification
- I
- II
- III
- IV
1640 (31.6%)
2677 (51.6%)
784 (15.1%)
85 (1.6%)
1158 (34.3%)
1643 (48.7%)
504 (14.9%)
69 (2.0%)
0.019


Table 2. Association Of Surgical Specialty And Outcomes
Specialty: OrthopedicsSpecialty: Plastic SurgeryP-value
Tendon repair(n=2737)(n=2003)
Operation time, m
Length of stay, d
Wound complication
Unplanned readmission
Unplanned reoperation
64.0 51.7
0.2 1.89
45 (1.6%)
33 (5.8%)
36 (1.3%)
67.8 51.
0.3 2.1
38 (1.9%)
16 (4.2%)
19 (0.9%)
0.275
0.043
0.754
0.991
0.992
Fractures(n=1967)(n=1059)
Operation time, m
Length of stay, d
Wound complication
Unplanned readmission
Unplanned reoperation
60.3 36.1
1.9 6.1
13 (0.7%)
12 (0.6%)
9 (0.5%)
60.2 36.0
2.7 7.6
12 (1.1%)
6 (0.6%)
10 (0.9%)
0.395
0.004
0.683
0.971
0.330
Amputation(n=573)(n=384)
Operation time, m
Length of stay, d
Wound complication
Unplanned readmission
Unplanned reoperation
40.0 29.8
0.2 1.8
26 (4.5%)
25 (0.9%)
25 (4.4%)
46.9 42.7
0.5 6.6
18 (4.7%)
11 (0.5%)
13 (3.4%)
0.780
0.928
1.000
1.000
1.000


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