The Effect of Surgeon Specialty on Acute Postoperative Complications after Carpometacarpal Arthroplasty

Abstract Carpometacarpal (CMC) joint arthroplasty is a common procedure performed by both orthopedic and plastic surgeons to address arthritis of the thumb CMC joint. The purpose of this study was to (1) compare the postoperative outcomes between orthopedic and plastic surgeons and (2) determine how surgeon specialty impacts rates of postoperative complications following CMC arthroplasty. All adult patients (>18 years) undergoing CMC arthroplasty were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2020. Patient demographic data and medical comorbidities were examined. Patients were classified as having a procedure by either an orthopedic surgeon or a plastic surgeon. Univariate analysis and multivariate logistic regression were used to assess the risk of postoperative complications and 30-day readmission based on surgeon specialty. A total of 5,162 patients undergoing CMC arthroplasty were included in our study, with 83.7% of procedures performed by orthopedic surgeons versus 16.3% performed by plastic surgeons. The incidence of surgical complications (p < 0.001), wound complications (p < 0.001), and superficial surgical site infections (SSIs; p < 0.001) was significantly higher when performed by plastic surgery. Additionally, operative time was significantly higher in cases performed by plastic surgeons (p = 0.001). On multivariate logistic regression, plastic surgery was independently associated with an increased risk of all complications (adjusted odds ratio [AORs] 2.70, 95% confidence interval [CI] 1.71–4.26), over four-fold increase in the risk of wound complications (AOR 4.49, 95% CI 2.53–7.97) and superficial SSI (AOR 5.06, 95% CI 2.72–9.39) when compared with orthopedic surgery. Despite similar patient demographics, CMC arthroplasty performed by plastic surgeons is independently associated with an increased risk of total postoperative complications, wound complications, and superficial infections when compared with orthopedic surgeons. Further investigation into perioperative and specialty-specific factors that contribute to discrepancies is warranted to improve outcomes and guide surgeon training. Level III, retrospective cohort study.