Practice Trends in Plastic Hand Surgery: An Evaluation of Cases in the TOPS Database

Abstract

Background Previous studies have sought to outline the clinical practice of hand surgeons with plastic surgery training backgrounds. Still, minimal data exist characterizing the scope of hand surgery among plastic surgeons, regardless of the subspecialty fellowship training.

Methods All hand procedures logged in the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database from 2002 to 2016 were identified by the Common Procedural Technology (CPT) code and/or “upper extremity” anatomic classification. Trends in the total number and types of procedures, facility type, admission type, modes and providers of anesthesia, and patient demographics were reviewed.

Results A total of 182,137 hand procedures performed on 82,811 patients during the 15-year period were reviewed. Sixty-eight percent of procedures involved soft tissue only, and 22.7% involved only bone and/or joint. The most common procedure categories included the following: wound closure/coverage (15.8%), debridement/drainage (15.3%), nerve (13.2%), tendon (12.9%), and fracture/dislocation (12.9%). Ambulatory and office-based procedures increased over time, along with the use of local anesthetic, as well as a transition from the procedural surgeon providing anesthesia to the use of anesthesiologists and nurse anesthetists. In addition, hand procedures have remained a considerable proportion of all logged procedures but have seen a steady decline since 2014.

Conclusion Plastic surgeons play an important role in the field of hand surgery, performing a wide variety of procedure types, which has remained stable over time. The trends in facility type and anesthesia characteristics have, however, varied.

Keywords

case types - hand surgery - plastic surgery - practice trends

^* These authors contributed equally and retain the first authorship.

Publication History

Article published online:
18 May 2023

• References

• 1 Brunworth LS, Chintalapani SR, Gray RR, Cardoso R, Owens PW. Resident selection of Hand Surgery Fellowships: a survey of the 2011, 2012, and 2013 Hand Fellowship graduates. Hand (N Y) 2013; 8 (02) 164-171
• 2 Mehta K, Pierce P, Chiu DTW, Thanik V. The effect of residency and fellowship type on hand surgery clinical practice patterns. Plast Reconstr Surg 2015; 135 (01) 179-186
• 3 Sears ED, Larson BP, Chung KC. Program director opinions of core competencies in hand surgery training: analysis of differences between plastic and orthopedic surgery accredited programs. Plast Reconstr Surg 2013; 131 (03) 582-590
• 4 Lifchez SD, Friedrich JB, Hultman CS. The scope of practice of hand surgery within plastic surgery: the ACAPS national survey to assess current practice and develop educational guidelines. Ann Plast Surg 2015; 74 (01) 89-92
• 5 Noland SS, Fischer LH, Lee GK, Friedrich JB, Hentz VR. Essential hand surgery procedures for mastery by graduating plastic surgery residents: a survey of program directors. Plast Reconstr Surg 2013; 132 (06) 977e-984e
• 6 ASPS. . Tracking Operations and Outcomes for Plastic Surgeons (TOPS). Accessed August 26, 2022 at: https://www.plasticsurgery.org/for-medical-professionals/registries/tracking-operations-and-outcomes-for-plastic-surgeons
• 7 Silvestre J, Upton J, Chang B, Steinberg DR. The impact of specialty on cases performed during hand surgery fellowship training. J Bone Joint Surg Am 2018; 100 (05) e29
• 8 AAHS.. A comparison of plastic and orthopaedic hand surgery curricula. Accessed August 25, 2022 at: https://meeting.handsurgery.org/abstracts/2015/66.cgi
• 9 Higgins JP. The diminishing presence of plastic surgeons in hand surgery: a critical analysis. Plast Reconstr Surg 2010; 125 (01) 248-260
• 10 Gupta V, Parikh R, Nguyen L. et al. Is office-based surgery safe? Comparing outcomes of 183,914 aesthetic surgical procedures across different types of accredited facilities. Aesthet Surg J 2017; 37 (02) 226-235
• 11 Cosmetic surgery national data bank statistics. Aesthet Surg J 2015; 35 (Suppl 2): 1-24
• 12 Grandizio LC, Graham J, Klena JC. Current trends in WALANT surgery: a survey of American Society for Surgery of the Hand members. J Hand Surg Glob Online 2020; 2 (04) 186-190
• 13 Huang YC, Chen CY, Lin KC, Yang SW, Tarng YW, Chang WN. Comparison of wide-awake local anesthesia no tourniquet with general anesthesia with tourniquet for volar plating of distal radius fracture. Orthopedics 2019; 42 (01) e93-e98
• 14 Chopan M, Samant S, Mast BA. Contemporary analysis of rhytidectomy using the tracking operations and outcomes for plastic surgeons database with 13,346 patients. Plast Reconstr Surg 2020; 145 (06) 1402-1408