Cutting Through Thigh Fasciotomies: A National Surgical Quality Improvement Program Analysis

Acute compartment syndrome is a relatively common condition of the leg, but thigh ACS is a rare pathology. Once recognized, treatment of thigh ACS relies on surgical release of the three main compartments of the thigh. The goal of this study was to analyze the frequency of thigh fasciotomies in patients diagnosed with thigh ACS.

The American College of Surgeons (ACS) National Surgical Quality Improvement Program database was used to analyze the incidence of thigh fasciotomies performed at participating hospitals from 2012 to 2023. Patients aged 18 y or older with a Current Procedural Terminology code for thigh fasciotomy (27,025) were included in the study.

We identified 165 patients who received thigh fasciotomies between 2013 and 2023. The patients were on average 46.0 y old (standard deviation, 17.6), primarily male (72.1%), non-Hispanic (69.7%), independent at baseline (93.9%), with leukocytosis (61.5%), and with an American Society of Anesthesiologists class III/IV (74.6%). Thirty-d mortality was 13.3%. In performing multivariate analysis, low albumin (OR: 12.27, P = 0.02) and age group 60-69 y old (OR: 15.03, P = 0.04) were the only variables with a statistically significant risk for mortality, while diabetes mellitus (OR: 0.12, P = 0.049) was a significant protector against mortality. The modified frailty index also significantly predicted outcomes following thigh fasciotomies (P = 0.004).

Thigh fasciotomies for ACS are rare procedures. Surgeons should be familiar with the known complications of thigh fasciotomies, and transfer to quaternary care centers for multidisciplinary care should be considered in patients who require the procedure.