Higher reoperation rates after flexor tendon repair found in older patients
In one of the first epidemiological studies to examine results after flexor tendon repair, researchers found a 6% reoperation rate during an 8-year period and identified older patients and those with workers’ compensation as having a higher risk for reoperation.
"We used a population-based data source to describe the frequency of secondary surgery, [and this was] 6% for re-repair or tenolysis following flexor tendon repair," Christopher J. Dy, MD, MSPH, of Hospital for Special Surgery, said during a recent presentation. "There was no improvement in outcomes as measured by frequency of reoperation over the study period."
Using the New York statewide hospital administrative database, Dy and colleagues Alexia Hernandez-Soria, MD; Huong Do, MA; Aaron Daluiski, MD; and Stephen Lyman, PhD, identified 5,229 flexor tendon repairs performed between 1998 and 2005. They examined patients’ demographic variables including age, gender and payer status, and looked for codes denoting tenolysis, re-repair and reoperation.
Age, insurance types
Of the 6.1% of patients who underwent reoperation, 91% were within 1 year of the index procedure at an average of 140 days. The investigators discovered that 58% of patients required tenolysis at an average of 183 days and 38% needed re-repair at an average of 35 days.
Patients aged 45 years to 64 years showed a higher reoperation rate than patients younger than 16 years, indicating that “advanced age may be predictive of tendon healing,” Dy said.
The researchers also found patients on workers’ compensation were 63% more likely to undergo reoperation compared to self payers or those on Medicare, Medicaid or private insurance.
"It is possible that higher injury severity could be sustained during work-related accidents or that substantial disability associated with poor outcomes after flexor tendon repair may contribute to the higher rates of reoperation seen for workers’ compensation patients in our population,"
Dy noted the study period may have been too short to adequately measure differences in outcomes.
"Our failure rate of flexor tendon repair has not changed over time, despite tremendous investment of resources," Dy said. "The diagnosis of rerupture or stiffness is challenging following initial flexor tendon repair, and each surgeon has a specific threshold on when to reoperate based on their previous experiences while biological and clinical factors contribute heavily in that surgeon’s decision to reoperate. Further evaluation of sociodemographic factors may be useful in shaping research agendas to minimize reoperation after flexor tendon repair. Further study is needed to investigate this rise in view of the considerable amount of resources that we dedicate towards flexor tendon repair."
Dy CJ. The epidemiology of re-operation after flexor tendon repair. Presented at: the 13th EFORT Congress; May 23-25, 2012; Berlin.
Disclosure: Dy has no relevant financial disclosures.