Practice Trends in Plastic Hand Surgery: An Evaluation of Cases in the TOPS Database

Previous studies have sought to outline the clinical practice of hand surgeons with plastic surgery training backgrounds. Still, minimal data exist characterizing the scope of hand surgery among plastic surgeons, regardless of the subspecialty fellowship training.

All hand procedures logged in the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database from 2002 to 2016 were identified by the Common Procedural Technology (CPT) code and/or "upper extremity" anatomic classification. Trends in the total number and types of procedures, facility type, admission type, modes and providers of anesthesia, and patient demographics were reviewed.

A total of 182,137 hand procedures performed on 82,811 patients during the 15-year period were reviewed. Sixty-eight percent of procedures involved soft tissue only, and 22.7% involved only bone and/or joint. The most common procedure categories included the following: wound closure/coverage (15.8%), debridement/drainage (15.3%), nerve (13.2%), tendon (12.9%), and fracture/dislocation (12.9%). Ambulatory and office-based procedures increased over time, along with the use of local anesthetic, as well as a transition from the procedural surgeon providing anesthesia to the use of anesthesiologists and nurse anesthetists. In addition, hand procedures have remained a considerable proportion of all logged procedures but have seen a steady decline since 2014.

Plastic surgeons play an important role in the field of hand surgery, performing a wide variety of procedure types, which has remained stable over time. The trends in facility type and anesthesia characteristics have, however, varied.