Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: analysis of a national cohort of 43 076 surgeries

Abstract

Objectives: To determine the incidence of further procedures and serious adverse events (SAEs) requiring admission to hospital following elective surgery for base of thumb osteoarthritis (BTOA), and the patient factors associated with these outcomes.

Design: Population based cohort study.

Setting: National Health Service using the national Hospital Episode Statistics data set linked to mortality records over a 19-year period (01 April 1998-31 March 2017).

Participants: 43 076 primary surgeries were followed longitudinally in secondary care until death or migration on 37 329 patients over 18 years of age.

Main outcome measures: Incidence of further thumb base procedures (including revision surgery or intra-articular steroid injection) at any time postoperatively, and local wound complications and systemic events (myocardial infarction, stroke, respiratory tract infection, venous thromboembolic events, urinary tract infection or renal failure) within 30 and 90 days. To identify patient factors associated with outcome, Fine and Gray model regression analysis was used to adjust for the competing risk of mortality in addition to age, overall comorbidity and socioeconomic status.

Results: Over the 19 years, there was an increasing trend in surgeries undertaken. The rate of further thumb base procedures after any surgery was 1.39%; the lowest rates after simple trapeziectomy (1.12%), the highest rates after arthroplasty (3.84%) and arthrodesis (3.5%). When matched for age, comorbidity and socioeconomic status, those undergoing arthroplasty and arthrodesis were 2.5 times more likely to undergo a further procedure (subHR 2.51 (95% CI 1.81 to 3.48) and 2.55 (1.91 to 3.40)) than those undergoing simple trapeziectomy. Overall complication rates following surgery were 0.22% for serious local complications and 0.58% for systemic events within 90 days of surgery.

Conclusions: The number of patients proceeding to BTOA surgery has increased over the last 19 years, with a low rate of further thumb base procedures and SAEs after surgery overall registered. Arthrodesis and arthroplasty had a significantly higher revision rate.

Trial registration number: NCT03573765.

Keywords: adult orthopaedics; epidemiology; hand & wrist; rheumatology; surgery.

Conflict of interest statement

Competing interests: All authors have completed an ICJME conflict of interest form that is uploaded with the study (http://www.icmje.org/conflicts-ofinterest/) no support from any organisation for the submitted work; DP-A has received research grants from Amgen, Servier, UCB; departmental fees for speaker services from Amgen, departmental fees for consultancy from UCB. JLR reports grants from the Medical Research Council (MR/K501256/1) and Versus Arthritis (21605), outside of the submitted work. NR reports personal fees from Acumed, outside the submitted work; Dr Craig reports grants from Royal College of Surgeons/National Joint Registry, outside the submitted work. No other relationships or activities could appear to have influenced the submitted work.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1

Data processing flow chart. BTOA, base of thumb osteoarthritis; LRTI, ligament reconstruction and tendon interposition.

Figure 2

Age-specific incidence of base of thumb osteoarthritis surgeries by year, England 1998–2017. LRTI, ligament reconstruction and tendon interposition.

Figure 3

Kaplan-Meier plot of risk of further thumb base procedure after all BTOA surgery, divided by sex. BTOA, base of thumb osteoarthritis.

Figure 4

Forest plot of relative risk of further thumb base procedure after primary base of thumb osteoarthritis surgery within multivariable regression analysis adjusted for age, sex, sociodemographic status and surgical subtype. LRTI, ligament reconstruction and tendon interposition.