TY - JOUR
T1 - Prevalence and Risk Factors for Postoperative Complications Following Open A1 Pulley Release for a Trigger Finger or Thumb
AU - Koopman, Jaimy E.
AU - Zweedijk, Bo E.
AU - the Hand-Wrist Study Group
AU - Hundepool, Caroline A.
AU - Duraku, Liron S.
AU - Smit, Jeroen
AU - Wouters, Robbert M.
AU - Selles, Ruud W.
AU - van der Avoort, D. J.J.C.
AU - Blomme, R. A.M.
AU - de Boer, H. L.
AU - van Couwelaar, G. M.
AU - Debeij, J.
AU - Dekker, J.
AU - van Ewijk, F. J.
AU - Feitz, R.
AU - Fink, A.
AU - de Haas, K. P.
AU - Harmsen, K.
AU - Hoogendam, L.
AU - Hovius, S. E.R.
AU - van Huis, R.
AU - Jansen-Landheer, M. L.
AU - Koch, R.
AU - van Kooij, Y. E.
AU - Kroeze, A.
AU - Moojen, T. M.
AU - van der Oest, M. J.W.
AU - Pennehouat, P. Y.
AU - de Ridder, W. A.
AU - de Schipper, J. P.
AU - Schoneveld, K.
AU - Slijper, H. P.
AU - Sluijter, B. J.R.
AU - Smit, X.
AU - Souer, J. S.
AU - ter Stege, M.
AU - Temming, J. F.M.
AU - Teunissen, J. S.
AU - van Uchelen, J. H.
AU - Veltkamp, J. J.
AU - Vermeulen, G. M.
AU - Walbeehm, E. T.
AU - Zöphel, O. T.
AU - Zuidam, J. Michiel
N1 - Funding Information:
The authors thank all patients who participated and allowed their data to be anonymously used for the present study.
Publisher Copyright:
© 2022
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Purpose: Although A1 pulley release is an effective treatment to reduce pain and improve hand function, complications may occur. More insight into risk factors for complications is essential to improve patient counseling and potentially target modifiable risk factors. This study aimed to identify factors associated with complications following A1 pulley release. Methods: Patients completed baseline questionnaires, including patient characteristics, clinical characteristics, and the Michigan Hand outcomes Questionnaire. We retrospectively reviewed medical records to identify complications classified using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions tool. Grade 1 complications comprise treatment with additional hand therapy, splinting, or analgesics, grade 2 treatment with antibiotics or steroid injections, grade 3A minor surgical treatment, grade 3B major surgical treatment, and grade 3C complex regional pain syndrome. Logistic regression analyses were performed to examine the contribution of patient characteristics, clinical characteristics, and patient-reported outcome measurement scores to complications. Results: Of the included 3,428 patients, 16% incurred a complication. The majority comprised milder grades 1 (6%) and 2 (7%) complications, followed by more severe grades 3B (2%), 3C (0.1%), and 3A (0.1%) complications. A longer symptom duration (standardized odds ratio [SOR], 1.09), ≥3 preoperative steroid injections (SOR, 3.22), a steroid injection within 3 months before surgery (SOR, 2.02), and treatment of the dominant hand (SOR, 1.34), index finger (SOR, 1.65), and middle finger (SOR, 2.01) were associated with a higher complication rate. Conclusion: This study demonstrates that ≥3 preoperative steroid injections and a steroid injection within 3 months before surgery were the most influential factors contributing to complications. These findings can assist clinicians during patient counseling and may guide preoperative treatment. We recommend that clinicians should consider avoiding steroid injections within 3 months before surgery and to be reluctant to perform >2 steroid injections. Type of study/level of evidence: Prognostic II.
AB - Purpose: Although A1 pulley release is an effective treatment to reduce pain and improve hand function, complications may occur. More insight into risk factors for complications is essential to improve patient counseling and potentially target modifiable risk factors. This study aimed to identify factors associated with complications following A1 pulley release. Methods: Patients completed baseline questionnaires, including patient characteristics, clinical characteristics, and the Michigan Hand outcomes Questionnaire. We retrospectively reviewed medical records to identify complications classified using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions tool. Grade 1 complications comprise treatment with additional hand therapy, splinting, or analgesics, grade 2 treatment with antibiotics or steroid injections, grade 3A minor surgical treatment, grade 3B major surgical treatment, and grade 3C complex regional pain syndrome. Logistic regression analyses were performed to examine the contribution of patient characteristics, clinical characteristics, and patient-reported outcome measurement scores to complications. Results: Of the included 3,428 patients, 16% incurred a complication. The majority comprised milder grades 1 (6%) and 2 (7%) complications, followed by more severe grades 3B (2%), 3C (0.1%), and 3A (0.1%) complications. A longer symptom duration (standardized odds ratio [SOR], 1.09), ≥3 preoperative steroid injections (SOR, 3.22), a steroid injection within 3 months before surgery (SOR, 2.02), and treatment of the dominant hand (SOR, 1.34), index finger (SOR, 1.65), and middle finger (SOR, 2.01) were associated with a higher complication rate. Conclusion: This study demonstrates that ≥3 preoperative steroid injections and a steroid injection within 3 months before surgery were the most influential factors contributing to complications. These findings can assist clinicians during patient counseling and may guide preoperative treatment. We recommend that clinicians should consider avoiding steroid injections within 3 months before surgery and to be reluctant to perform >2 steroid injections. Type of study/level of evidence: Prognostic II.
UR - http://www.scopus.com/inward/record.url?scp=85132875083&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2022.04.017
DO - 10.1016/j.jhsa.2022.04.017
M3 - Article
C2 - 35718583
AN - SCOPUS:85132875083
SN - 0363-5023
VL - 47
SP - 823
EP - 833
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 9
ER -