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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.
Purpose:
This study aimed to characterize the rate and risk factors for complications following congenital upper limb surgery.
Methods:
A total of 2,430 surgical procedures performed in 1,930 patients from 2014 to 2024 were analyzed from the Congenital Upper Limb Differences Registry. Complications were identified through surgeon self-reporting, categorized using the Clavien-Dindo classification system, and further classified based on timing (early vs late). Multivariable logistic regression analysis was used to identify independent risk factors for complications.
Results:
There were 100 patients with 130 complications, for an overall complication rate of 5.3%. Seventy-six patients had a single complication, 18 patients had two complications, and six presented three complications. According to the Clavien-Dindo classification, there were 34 type I, 45 type II, 50 type III, and one type IV complications. There were 77 early complications and 53 late events. When excluding Clavien--Dindo type I complications, which by definition did not affect clinical care, the complication rate was 4.1%. The most severe complications were compartment syndrome post-osteotomy for radioulnar synostosis and vascular compromise following a pollicization. More complications were seen after reconstructive surgery for syndactyly, thumb deficiency, and polydactyly. No considerable associations were detected between postoperative complications and medical comorbidities, syndromic associations, bilateral involvement, or hand plate malformations.
Conclusions:
The overall complication rate following congenital upper limb surgery was approximately 5.3%, with most events being minor and not requiring additional surgery. Complications were most frequently observed following procedures for syndactyly, thumb hypoplasia, and polydactyly; however, no definitive patient-specific risk factors were found. These results, drawn from high-volume pediatric centers, underscore the multifactorial nature of surgical outcomes and the value of prospective multicenter data in benchmarking complication rates.
Type Of Study/Level Of Evidence:
Prognosis IIb.
