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National Surgical Incidence and Sociodemographic Differences for Pediatric Polydactyly of the Hand
Bill Young1, Gabriella B Smith1, Ashley L Titan2
1Stanford University School of Medicine, Redwood City, CA, USA.
Insights
Pediatric polydactyly diagnoses and surgeries have declined. Suture ligation rates remain stable, with surgery being more costly and linked to younger age and higher comorbidities.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Health Services Research
Background:
- Polydactyly management and surgical trends lack comprehensive characterization.
- Understanding national pediatric polydactyly treatment patterns is crucial for care guidelines.
Purpose of the Study:
- To analyze national pediatric polydactyly management trends.
- To evaluate operative and procedural patterns, timing of treatment, and associated factors.
- To compare costs and complications of different interventions.
Main Methods:
- Utilized the PearlDiver national administrative claims database (2010-2023).
- Identified pediatric patients (≤18 years) diagnosed with polydactyly.
- Analyzed surgical correction and suture ligation procedures, including costs and complications.
Main Results:
- A decrease in polydactyly diagnosis and surgery rates observed over the decade.
- Suture ligation rates remained stable; surgery rates declined from 12.0% (2010) to 7.3% (2020).
- Younger age and higher comorbidity index predicted surgery; higher income correlated with lower likelihood. Surgery incurred higher costs.
Conclusions:
- A notable decline in pediatric polydactyly incidence and surgical intervention rates was identified.
- Findings can guide future pediatric hand care guidelines and clinical discussions.
Background:
Polydactyly surgery rates and trends are poorly characterized. The purpose of this study was to characterize national pediatric polydactyly management by examining operative and procedural trends over time, evaluating timing of treatment, identifying factors associated with interventions, and comparing costs and complications.
Methods:
We used the PearlDiver national administrative claims database to identify pediatric patients aged 18 and under with a diagnosis of polydactyly (2010-2023). We analyzed patients who received procedures coded as surgical correction or suture ligation, then characterized rates and factors associated with each intervention, and investigated postoperative complication rates.
Results:
Of 42 543 polydactyly patients, 3880 patients (9.1%) underwent surgery, and 5612 patients (13.2%) underwent procedures coded as suture ligation. Over the past decade, the incidence of polydactyly diagnosis and surgery has decreased, while rates of procedures coded as suture ligation have not changed significantly. In 2010, 12.0% of patients underwent surgery, compared to 7.3% in 2020. Patients of ages 1 to 2 years comprised the greatest proportion of the population who underwent surgical operations at 1729 patients (36.0%), and patients of ages 0 to 1 year comprised the greatest proportion of the population who underwent suture ligations at 3327 patients (51.0%) (P < .001). Younger age at diagnosis and higher comorbidity index were associated with a greater likelihood of surgery, while greater mean family income was associated with a lower likelihood. Among treatment categories, surgery was associated with greater 1-year and total payer-reimbursed costs (P < .05).
Conclusions:
We observed a declining incidence of pediatric polydactyly and polydactyly surgery. These findings may inform future guideline development and discourse for pediatric hand care.
