Trends in the Management of Acute Pyogenic Flexor Tenosynovitis of the Hand: A Comprehensive Analysis

Background Acute pyogenic flexor tenosynovitis (APFT) is typically managed operatively, but there is growing interest in nonoperative treatments using intravenous (IV) antibiotics to reduce surgical complications. Timely intervention is essential, as delayed treatment increases the risk of systemic, life-threatening infections. This study aimed to characterize national trends in the operative management of APFT and to compare mortality and amputation outcomes between operatively and nonoperatively managed patients. Methods A retrospective analysis was conducted using data from the TriNetX United States Collaborative Network from 2015 to 2023. Patients were identified using ICD-10 and CPT codes and categorized into operative and nonoperative cohorts, further stratified by body mass index (BMI) (20-29 and 30-39). Primary outcomes included the incidence and prevalence of surgical interventions, while secondary outcomes assessed mortality, amputation rates, and the risk of surgery and reoperation based on BMI. Propensity score matching was performed to control for confounders. Results The study included 2,200 operative and 4,099 nonoperative patients. Risk factors such as nicotine dependence, tobacco use, and diabetes increased the likelihood of surgery. From 2015 to 2023, the incidence of tendon sheath drainage rose from 0.59% to 13.29%, with surgical prevalence increasing to 35.38%. Operative management - likely reflecting more severe infection at presentation - was associated with higher five-year mortality (OR 1.284) and amputation (OR 2.400). Surgery rates were significantly higher in the BMI 30-39 group. Conclusion APFT poses a serious risk, with increased surgery rates linked to certain risk factors. Educating patients on modifiable risks is critical for reducing APFT incidence.