Complications in Hand Surgery During Early Independent Practice: A Single Surgeon's 5-Year Experience

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Upper Extremity Surgery

Background:

• Assessing complication frequency and outcomes is crucial for early-career hand and upper extremity surgeons.
• Understanding postoperative outcomes within the first five years of practice is essential for surgical training and patient care.

Purpose of the Study:

• To determine the frequency and types of complications following hand and upper extremity surgery.
• To evaluate postoperative outcomes associated with these complications within the initial five years of independent practice.

Main Methods:

• Retrospective observational study of 3301 surgeries performed between August 2014 and September 2019.
• Data included patient demographics, perioperative details, and complication classification using Clavien-Dindo and a novel system.
• Analysis focused on complication rates, types, and patient outcomes (improved/same/worse).

Main Results:

• The overall complication rate was 7.9% (261/3301), with a 30-day rate of 5.2% (171/3301).
• A significant decline in total complications was observed over the five years (74 to 33, P=.010).
• Superficial infections were the most frequent complication; hand and wrist surgeries and bone pathology were most common indications.

Conclusions:

• The overall surgical complication rate in hand and upper extremity surgery is 7.9%, with a 5.2% 30-day rate.
• Complication rates significantly decrease during the first five years of post-fellowship practice.
• Over 90% of patients experienced improvement after complication management, with superficial infections being most common.