The Epidemiology of Reoperation After Flexor Pulley Reconstruction

Abstract

Purpose We used a statewide database to determine the incidence of pulley reconstruction and to evaluate the influence of demographics on reoperation. We hypothesized that age, insurance status, and concomitant nerve or tendon procedure would influence the likelihood of reoperation. Methods We used the Statewide Planning and Research Cooperative System ambulatory surgery database from New York, which represents all outpatient surgery in the state. Patients who had flexor pulley reconstruction from 1998 to 2009 were identified using Current Procedural Terminology 4 codes. Subsequent surgery records for these patients were identified through 2010, allowing at least 1 year follow-up. Concomitant nerve procedure and flexor tendon repair/reconstruction were identified. The type and timing of subsequent procedures, including tenolysis and repeat pulley reconstruction, were recorded. Univariate statistics were calculated to compare age, sex, and payer type between patients with and without reoperation. A multivariable, logistic regression model was used to evaluate the association of the demographics with the chances of having reoperation. Results There were 623 patients who had flexor pulley reconstruction from 1998 to 2009. The incidence of pulley reconstruction was 0.27 per 100,000 persons, with an annual frequency of 52 procedures. There were 39 (6%) reoperations. There was no difference in age, concomitant nerve or tendon repair, or workers’ compensation between patients with and without reoperation. Regression modeling showed a higher likelihood among men of having reoperation. Conclusions Flexor pulley reconstructions are rare. One-quarter of surgeons performed only one flexor pulley reconstruction over a 12-year period. The 6% reoperation rate is similar to our previous findings for flexor tendon repair using similar methodology. Our report provides information that may be useful in counseling patients. Type of study/level of evidence Prognostic II.

The Quality of Control Groups in Nonrandomized Studies Published in the Journal of Hand Surgery

“…Age and sex were variables matched in 4 studies (23, 24, 33, 34). Although more statistically advanced, few studies (14%) used post hoc analysis to adjust for confounding (17, 19, 35, 36). In total, 30(81%) studies used at minimum one method to control for confounding.…”

“…Regression models can estimate intervention effect adjusted for imbalances in observed prognostic factors (3, 43). Dy et al used multivariable regression analysis to evaluate the influence of demographics on reoperation for flexor pulley reconstruction (35). They found a higher likelihood of reconstruction among men, after adjusting for age and concomitant nerve and flexor tendon repair.…”

“…This analysis improved the validity of conclusions by adjusting for exposures that would otherwise be confounders. However, the authors acknowledged that the factors they found to influence reoperation were in fact surrogates for injury severity (35). Thus the influence of injury severity may not be truly represented in this study.…”

A Potentially Inexpensive Diagnostic Method for A2 Pulley Ruptures

“…The increasing prevalence of activities such as rock climbing has led to an increase in injuries of the A2 pulley, likely due to the unique biomechanics of the "crimping" grip used in climbing [2]. One study reported a 58% incidence of flexor pulley injury as a result of rock climbing in a sample size of 623 patients, and of those patients, 52% involved the middle finger and 50% involved the A2 pulley [3].…”

The Effect of Wrist Position on Finger Tendon Loads Following Pulley Sectioning and Operative Reconstruction

“…It is estimated that 6% of patients who undergo surgical reconstruction experience complications such as bowstringing, stiffness, and pain in the midst of rehabilitation. 14,15,21 One of many reasons stiffness in the finger occurs after reconstruction is believed to be inadequate gliding of flexor tendons. The cause and risk for such impediments, however, are neither well-described nor well-understood within the current clinical literature.…”