Free-vascularized bone grafts for scaphoid non-unions viable as outpatient procedure?
No 30-day complications in NSQIP data.
DOI:
https://doi.org/10.55576/job.v1i2.6Keywords:
Scaphoid fracture, Scaphoid Nonunion, Free vascularized bone graft, Ambulatory surgery, Outpatient surgery, Cost effectivenessAbstract
Objective: To determine if free vascularized bone grafting procedures are considered safe to perform for outpatient treatment in the setting of scaphoid non-union.
Setting: Utilizing The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) scaphoid nonunion cases were isolated and investigated.
Patients/Participants: A total of 50 patients with scaphoid fractures treated with vascularized bone graft were identified.
Intervention: Bone graft with microvascular anastomosis for closed fracture of the scaphoid
Main Outcome Measurements: Length of hospital stay, acute (30 day) complication rates
Results: The average length of hospital stay was 1.2 days and 18 patients (36%) were discharged the same day of surgery. There were no complications reported within the 30-day post-operative period.
Conclusion: The reported early morbidity and mortality rates of free vascularized bone grafting in the setting of scaphoid fractures have been reported to be minimal. These rare early complications include superficial surgical site infections and pin site irritation. In this analysis, there were no reported adverse outcomes. Given the low risks for acute complications, vascularized bone transfer surgery in the setting of scaphoid nonunion can be considered safe and potentially cost effective to perform on an outpatient basis.
Level of Evidence: IV
Keywords: Scaphoid fracture; scaphoid nonunion; free vascularized bone graft; ambulatory surgery; outpatient surgery; cost effectiveness
(J Ortho Business 2021 Oct 1;1(2):5-8)
References
Kollitz KM, Pulos N, Bishop AT, Shin AY. Primary medial femoral condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis. J Hand Surg Eur Vol. Jul 2019;44(6):600-606. doi:10.1177/1753193418789329
Bumbasirevic M, Stevanovic M, Bumbasirevic V, Lesic A, Atkinson HD. Free vascularised fibular grafts in orthopaedics. Int Orthop. Jun 2014;38(6):1277-82. doi:10.1007/s00264-014-2281-6
Nandra B, Fattahi T, Martin T, Praveen P, Fernandes R, Parmar S. Free Bone Grafts for Mandibular Reconstruction in Patients Who Have Not Received Radiotherapy: The 6-cm Rule-Myth or Reality? Craniomaxillofac Trauma Reconstr. Jun 2017;10(2):117-122. doi:10.1055/s-0036-1597583
Ghassemi A, Ghassemi M, Riediger D, Hilgers RD, Gerressen M. Comparison of donor-site engraftment after harvesting vascularized and nonvascularized iliac bone grafts. J Oral Maxillofac Surg. Aug 2009;67(8):1589-94. doi:10.1016/j.joms.2009.04.013
Aibinder WR, Wagner ER, Bishop AT, Shin AY. Bone Grafting for Scaphoid Nonunions: Is Free Vascularized Bone Grafting Superior for Scaphoid Nonunion? Hand (N Y). 03 2019;14(2):217-222.
Sawaizumi T, Nanno M, Nanbu A, Ito H. Vascularised bone graft from the base of the second metacarpal for refractory nonunion of the scaphoid. J Bone Joint Surg Br. Sep 2004;86(7):1007-12.
Chang MA, Bishop AT, Moran SL, Shin AY. The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg Am. Mar 2006;31(3):387-96. doi:10.1016/j.jhsa.2005.10.019
Doi K, Oda T, Soo-Heong T, Nanda V. Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg Am. May 2000;25(3):507-19.
Jones DB, Moran SL, Bishop AT, Shin AY. Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. Apr 2010;125(4):1176-84.
Jones DB, Bürger H, Bishop AT, Shin AY. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts. J Bone Joint Surg Am. Dec 2008;90(12):2616-25. doi:10.2106/JBJS.G.01503
Flinn DC, Gurnea TP, Althausen PK. Financial Impact of the Surgical Treatment of Infection on the Practice of Orthopedic Trauma. Journal of Orthopaedic Business. 2021;1(1) 1-3
Green C, Polmear M, Dunn J, Parnes N, Scanaliato J. Care of low-income patients with sports injuries disincentivized by government reimbursement. Journal of Orthopaedic Business. 2021;1(1) 4-7
Hulet C, Souquet D, Alexandre P, Locker B, Beguin J, Vielpeau C. Arthroscopic treatment of 105 lateral meniscal cysts with 5-year average follow-up. Arthroscopy. Oct 2004;20(8):831-6.
Mira JJ, Tomás O, Virtudes-Pérez M, Nebot C, Rodríguez-Marín J. Predictors of patient satisfaction in surgery. Surgery. May 2009;145(5):536-41. doi:10.1016/j.surg.2009.01.012
Novak PJ, Bach BR, Bush-Joseph CA, Badrinath S. Cost containment: a charge comparison of anterior cruciate ligament reconstruction. Arthroscopy. Apr 1996;12(2):160-4. doi:10.1016/s0749-8063(96)90005-5
Lovald ST, Ong KL, Malkani AL, et al. Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty. Mar 2014;29(3):510-5. doi:10.1016/j.arth.2013.07.020
Crawford DC, Li CS, Sprague S, Bhandari M. Clinical and Cost Implications of Inpatient Versus Outpatient Orthopedic Surgeries: A Systematic Review of the Published Literature. Orthop Rev (Pavia). Dec 28 2015;7(4):6177. doi:10.4081/or.2015.6177
Waterman BR, Dunn JC, Bader J, Urrea L, Schoenfeld AJ, Belmont PJ. Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. J Shoulder Elbow Surg. Jan 2015;24(1):24-30. doi:10.1016/j.jse.2014.05.016
Schoenfeld AJ, Herzog JP, Dunn JC, Bader JO, Belmont PJ. Patient-based and surgical characteristics associated with the acute development of deep venous thrombosis and pulmonary embolism after spine surgery. Spine (Phila Pa 1976). Oct 2013;38(21):1892-8.
Clay NR, Dias JJ, Costigan PS, Gregg PJ, Barton NJ. Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br. Sep 1991;73(5):828-32.
Wells ME, Nicholson TC, Macias RA, Nesti LJ, Dunn JC. Incidence of Scaphoid Fractures and Associated Injuries at US Trauma Centers. J Wrist Surg. Apr 2021;10(2):123-128. doi:10.1055/s-0040-1720963
Buijze GA, Ochtman L, Ring D. Management of scaphoid nonunion. J Hand Surg Am. May 2012;37(5):1095-100; quiz 1101. doi:10.1016/j.jhsa.2012.03.002
Dinah AF, Vickers RH. Smoking increases failure rate of operation for established non-union of the scaphoid bone. Int Orthop. Aug 2007;31(4):503-5. doi:10.1007/s00264-006-0231-7
Little CP, Burston BJ, Hopkinson-Woolley J, Burge P. Failure of surgery for scaphoid non-union is associated with smoking. J Hand Surg Br. Jun 2006;31(3):252-5. doi:10.1016/j.jhsb.2005.12.010
Pulos N, Kollitz KM, Bishop AT, Shin AY. Free Vascularized Medial Femoral Condyle Bone Graft After Failed Scaphoid Nonunion Surgery. J Bone Joint Surg Am. Aug 15 2018;100(16):1379-1386.
Arora R, Lutz M, Zimmermann R, Krappinger D, Niederwanger C, Gabl M. Free vascularised iliac bone graft for recalcitrant avascular nonunion of the scaphoid. J Bone Joint Surg Br. Feb 2010;92(2):224-9. doi:10.1302/0301-620X.92B2.22367
Ibrahim T, Qureshi A, Sutton AJ, Dias JJ. Surgical versus nonsurgical treatment of acute minimally displaced and undisplaced scaphoid waist fractures: pairwise and network meta-analyses of randomized controlled trials. J Hand Surg Am. Nov 2011;36(11):1759-1768.e1. doi:10.1016/j.jhsa.2011.08.033
Bertin KC. Minimally invasive outpatient total hip arthroplasty: a financial analysis. Clin Orthop Relat Res. Jun 2005;(435):154-63. doi:10.1097/01.blo.0000157173.22995.cf
Kolisek FR, McGrath MS, Jessup NM, Monesmith EA, Mont MA. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res. Jun 2009;467(6):1438-42.
Aynardi M, Post Z, Ong A, Orozco F, Sukin DC. Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J. Oct 2014;10(3):252-5. doi:10.1007/s11420-014-9401-0
Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. Jun 2011;93(11):994-1000. doi:10.2106/JBJS.I.01618
Kao JT, Giangarra CE, Singer G, Martin S. A comparison of outpatient and inpatient anterior cruciate ligament reconstruction surgery. Arthroscopy. Apr 1995;11(2):151-6. doi:10.1016/0749-8063(95)90060-8
Krywulak SA, Mohtadi NG, Russell ML, Sasyniuk TM. Patient satisfaction with inpatient versus outpatient reconstruction of the anterior cruciate ligament: a randomized clinical trial. Can J Surg. Jun 2005;48(3):201-6.
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