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Complications Following Congenital Hand and Upper Limb Surgery: Lessons From the CoULD Registry
Donald S Bae1, Maria F Canizares1, Danielle L Cook1
1Boston Children's Hospital, Boston, MA.
The Journal of Hand Surgery
|January 7, 2026
Summary
The overall complication rate for congenital upper limb surgery is 5.3%, with most events being minor. Procedures for syndactyly, thumb deficiency, and polydactyly had higher complication rates, but no specific patient risk factors were identified.
Area of Science:
- Pediatric Surgery
- Orthopedic Surgery
- Hand Surgery
Background:
- Congenital upper limb differences require surgical intervention.
- Characterizing complication rates is crucial for improving patient outcomes.
- Understanding risk factors can guide surgical decision-making.
Purpose of the Study:
- To determine the incidence and types of complications after congenital upper limb surgery.
- To identify patient-specific risk factors associated with these complications.
Main Methods:
- Analysis of 2,430 procedures in 1,930 patients from the Congenital Upper Limb Differences Registry (2014-2024).
- Complications were classified using the Clavien-Dindo system and by timing (early/late).
- Multivariable logistic regression was employed to identify risk factors.
Main Results:
- An overall complication rate of 5.3% was observed (130 complications in 100 patients).
- Most complications were minor (Clavien-Dindo type I/II), with 4.1% affecting clinical care.
- Higher complication rates were noted after surgery for syndactyly, thumb deficiency, and polydactyly.
Conclusions:
- Congenital upper limb surgery has a 5.3% complication rate, predominantly minor.
- No significant patient-specific risk factors were identified.
- Multicenter data are valuable for benchmarking surgical outcomes.
