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Characterizing the Timing of Surgical Repair of Congenital Hand Differences in the United States
Olivia W Cummings1, Daniel J Koh1,2, Jungho Gong1
1The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Insights
Surgical timing for congenital hand differences often deviates from expert recommendations in the U.S. This study analyzed national trends, finding inconsistencies in reconstructions for syndactyly and polydactyly, impacting functional and aesthetic outcomes.
Area of Science:
- Pediatric Surgery
- Hand Surgery
- Congenital Anomalies
Background:
- Optimal timing for surgical reconstruction of congenital hand differences is debated.
- Timely intervention aims to restore near-normal appearance and function.
- National practice patterns for surgical timing require evaluation.
Purpose of the Study:
- To evaluate national trends in the timing of surgical reconstruction for congenital hand differences.
- To determine if current surgical practices align with established literature recommendations.
- To analyze the influence of surgeon subspecialty on repair timing.
Main Methods:
- Identified recommended surgical ages for congenital hand differences.
- Queried the Pediatric National Surgical Quality Improvement Project database (2012-2020).
- Analyzed surgeries for simple syndactyly, complex syndactyly, polydactyly, and congenital trigger finger, including subspecialty influence.
Main Results:
- Congenital trigger finger and complex syndactyly reconstructions largely met recommended timing.
- Polydactyly repairs were often performed earlier than recommended.
- Simple syndactyly reconstructions were split between earlier and later timing; plastic surgeons favored younger polydactyly repair.
Conclusions:
- Established expert recommendations for congenital hand difference treatment are frequently not followed in U.S. practice.
- Surgical timing practices may not be driven by current scientific literature.
- Further research is needed to understand and potentially standardize surgical timing for improved patient outcomes.
Abstract:
Background: Suggested timing of reconstruction of congenital hand differences varies widely. The goal of timely intervention is to achieve near-normal appearance and function. We evaluated national trends in surgical timing of congenital hand differences to determine whether interventions align with the literature. Methods: Recommended ages for surgical reconstruction were identified. The Pediatric National Surgical Quality Improvement Project database was queried from 2012 to 2020 for children who underwent surgery for simple syndactyly (SS), complex syndactyly (CS), polydactyly, or congenital trigger finger. Subgroup analysis was conducted to assess whether the surgeon's subspecialty (plastic surgery vs orthopedic surgery, pediatric vs generalist) influenced the timing of repair. Results: Congenital trigger finger and CS reconstructions occurred largely within the recommended age range (73.8% and 52.2%, respectively). Polydactyly repairs primarily occurred earlier than the recommendations (54.0%). Timing of SS reconstruction was split, either occurring before (44.3%) or after (41.4%) the recommendations. For children with polydactyly, plastic surgeons were more likely to perform polydactyly reconstruction at a younger age compared with orthopedic surgeons (P = .0001). Conclusions: Established expert recommendations for the treatment of congenital hand differences are largely not followed in practice in the United States. This suggests that practice patterns may not be determined by the surgical literature.
