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Complications in the 2-Year Postoperative Period Following Pediatric Syndactyly Release
Kelly E Edwards1, Nicholas P Gannon1, Susan A Novotny2
1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
Insights
Syndactyly release surgery has a 31% complication rate, with unplanned cast changes being most common. Performing multiple releases per surgery or undergoing multiple surgical events increases complication risk.
Area of Science:
- Pediatric surgery
- Congenital hand surgery
- Plastic surgery
Background:
- Syndactyly release is a common pediatric hand surgery.
- Understanding associated complications is crucial for patient outcomes.
Purpose of the Study:
- To evaluate complications of syndactyly release.
- Identify factors correlating with higher complication rates within two years post-surgery.
Main Methods:
- Retrospective chart review of patients undergoing syndactyly release (2005-2018).
- Exclusion criteria included cleft hand, incomplete documentation, and limited follow-up.
- Complications classified using the Clavien-Dindo (CD) system.
Main Results:
- 85 surgeries involved 143 web releases in 59 patients.
- 27 complications occurred across 85 surgeries (31% rate).
- CD grade I/II complications (23%) were mainly cast changes; CD grade III (8%) included 6 reoperations. Higher complication rates observed with >1 web release per surgery and >1 surgical event. No association found with concomitant diagnoses or syndactyly complexity.
Conclusions:
- Syndactyly release has a 31% complication rate per surgical event.
- 44% of complications involved unplanned cast changes; 8% required admission or reoperation.
- Risk factors include performing multiple web releases per surgery and undergoing multiple surgical events.
Purpose:
Syndactyly surgical release is one of the most common congenital hand surgeries performed by pediatric hand surgeons. The purpose of our study was to evaluate the complications associated with syndactyly release and determine factors that correlate with higher complication rates within the 2-year postoperative period.
Methods:
A retrospective chart review was completed for patients who underwent syndactyly release at a single pediatric center between 2005 and 2018. Patients were included if they had a diagnosis of syndactyly and underwent surgical release, and excluded for a diagnosis of cleft hand, incomplete surgical documentation, surgery performed at an outside institution, or follow-up care that did not extend beyond the first postoperative visit. Complications were classified using the Clavien-Dindo (CD) system.
Results:
Fifty-nine patients met the inclusion criteria, which included 143 webs released in 85 surgeries. A total of 27 complications occurred for the 85 surgeries performed. The severity of complications was CD grade I or II in 23% of surgeries, most commonly unplanned cast changes, and CD grade III in 8% of surgeries. No CD grade IV or V complications occurred. The CD grade III complications included 6 reoperations. The complication rate was higher when performing >1 syndactyly release per surgery. It also was higher for patients undergoing >1 surgical event. Rates of complication per surgery were similar between patients with multiple surgeries compared with those with a single surgery. Concomitant diagnoses and complexity of syndactyly was not associated with a higher complication rate.
Conclusions:
Syndactyly release was associated with a complication rate of 31% per surgical event with 44% of these complications related to unplanned cast changes and 8% of complications that required admission or reoperation. Risk factors for complications following syndactyly release include >1web operated on per surgery and undergoing >1 surgical event.
Type Of Study/Level Of Evidence:
Prognosis IV.
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