Revision A1 Pulley Release: An Analysis of Risk Factors Using a National Database.

J Hand Surg Am

Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL. Electronic address:

Published: October 2024

AI Article Synopsis

  • Trigger finger release (TFR) is a common hand surgery procedure with a high success rate, but some patients may need revision surgery (rTFR) and little is known about what factors lead to this.
  • A study analyzed data from over 46,000 patients who underwent TFR from 2015 to 2022 to identify demographic and health factors associated with the need for rTFR.
  • Results indicated that male sex, diabetes, and ischemic heart disease significantly increased the odds of requiring revision surgery, while hypothyroidism decreased these odds across all time frames.

Article Abstract

Purpose: Trigger finger release (TFR) is a commonly performed procedure in hand surgery. Trigger finger release has a high success rate, but recurrence can occur. Data on revision TFR (rTFR) are sparse, with little known regarding factors associated with the need for revision surgery. Our purpose was to analyze risk factors associated with rTFR procedures.

Methods: Using a national database (PearlDiver Research Program), patients who underwent TFR between 2015 and 2022 were identified using Current Procedural Terminology and International Classification of Diseases (ICD)-10 codes. Patients were included if they received an ICD-10 diagnosis of trigger finger on the same day as their release or within 2 weeks of their procedure. Patients who underwent rTFR were determined through identification of a secondary procedure completed in the same digit on the ipsilateral hand performed after the index procedure. Revision rates at 1, 3, and 5 years were recorded. Demographics and comorbidities were categorically examined via univariate and multivariable logistic regression analyses.

Results: A total of 46,613 patients meeting inclusion criteria were identified after TFR with 1,793 (3.85%) undergoing revision release. Multivariable analysis demonstrated that diabetes, ischemic heart disease, and male sex were associated with statistically significantly increased odds of revision procedures at 1, 3, and 5 years from the initial operation. Age >65 years and hypertension were associated with an increased odds of revision surgery at 3 and 5 years, and carpal tunnel syndrome as a risk factor at 1 and 3 years only. Hypothyroidism was associated with a decreased revision rate at all time points and tobacco use at 5 years only.

Conclusions: These data demonstrate that male sex, diabetes, and heart disease are risk factors for requiring revision TFR in the short and medium terms. This information can add to preoperative counseling with patients undergoing surgical treatment of trigger digits.

Type Of Study/level Of Evidence: Prognostic II.

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Source
http://dx.doi.org/10.1016/j.jhsa.2024.09.016DOI Listing

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