Low rates of serious complications and further procedures following surgery for Base of Thumb Osteoarthritis: analysis of a national cohort of 43 076 surgeries
LANE J., Craig R., REES J., GARDINER M., mikhail M., riley N., PRIETO ALHAMBRA D., FURNISS D.
Objectives To determine the incidence of further procedures and serious adverse events (SAE) requiring admission to hospital following elective surgery for base of thumb osteoarthritis (BTOA), and the patient factors associated with these outcomes. Design Population based cohort study Setting National Health Service (NHS) using the national Hospital Episode Statistics dataset linked to mortality records over a 19-year period (01/04/1998-31/03/2017). Participants 43 076 primary surgeries were followed longitudinally in secondary care until death or migration on 37 329 patients over 18 years of age. Main Outcome measures Incidence of further thumb base procedures (including revision surgery or intra-articular steroid injection) at any time post-operatively, and local wound complications and systemic events (myocardial infarction, stroke, respiratory tract infection, venous thromboembolic events, urinary tract infection or renal failure) within 30 and 90 days. To identify patient factors associated with outcome, Fine and Gray model regression analysis was used to adjust for the competing risk of mortality in addition to age, overall comorbidity and socioeconomic status. Results Over the 19-years, there was an increasing trend in surgeries undertaken. The rate of further thumb base procedures after any surgery was 1.39%; the lowest rates after simple trapeziectomy (1.12%), the highest rates after arthroplasty (3.84%), and arthrodesis (3.5%). When matched for age, comorbidity and socioeconomic status, those undergoing arthroplasty and arthrodesis were 2.5 times more likely to undergo a further procedure (subhazard ratio 2.51 [95%CI 1.81-3.48]) and 2.55 [1.91-3.40]) than those undergoing simple trapeziectomy. Overall complication rates following surgery were 0.22% for serious local complications and 0.58% for systemic events within 90 days of surgery. Conclusions The number of patients proceeding to BTOA surgery has increased over the last 19 years, with a low rate of further thumb base procedures and SAEs after surgery overall registered. Arthrodesis and arthroplasty had a significantly higher revision rate.