Epidemiology and Outcomes of Upper Limb Surgery: Analysis of Routine Data

NCT03573765 | Completed

• 2 other identifiers: 12787DARS-NIC-29827-Q8Z7Q
• Study Type: observational
• Target: 8,308,821
• Locations: 0 countries
• Sites: N/A

Brief Summary

Surgery is a common treatment type for damaged joints, tendons and nerves in the upper limb where conservative measures are inappropriate or have failed. These conditions are common and result in significant levels of pain and functional disability. The investigators are conducting a broad ranging study of variation in the provision of surgical treatment and factors affecting outcomes after surgical treatment of upper limb conditions. This will be a population-based study of all patients undergoing surgical treatment funded by the National Health Service (NHS) of England over a nineteen-year period. This study will help to understand the factors associated with a poor outcome following surgery, which can be shared with patients considering treatment options. The investigators will also document current and future health service burden associated with commonly performed surgical procedures including complications and repeat operations.

Conditions

Osteoarthritis; Dislocations; Inflammatory Arthritis; Rotator Cuff Tear; Shoulder Dislocation; Upper Limb Nerve Lesion; Shoulder Arthropathy; Elbow Arthropathy; Wrist Arthropathy; Arthropathy Unspecified, Involving Hand; Fracture, Shoulder; Fracture Elbow; Fracture Wrist and Hand; Dupuytren Contracture; Impingement Syndrome, Shoulder; Trigger Digit; Avascular Necrosis

Keywords

epidemiology; upper limb; hand surgery; wrist surgery; shoulder surgery; elbow surgery; outcomes; complications; revision surgery

Outcome Measures

Primary Outcomes (3)

• Revision and reoperation

  Estimated at annual increments and standardised lifetime risk

  1998-2017

• Treatment volume: time series

  Crude and adjusted for population by age/sex

  1998-2017

• Treatment volume: geospatial patterns

  Mapped according to residence and NHS organisation boundaries

  1998-2017

Secondary Outcomes (4)

• Complications

  30, 45, 60, 90 days post surgery + 1 year and last recorded follow-up/censoring.

• Length of stay post surgery

  up to 52 weeks from date of surgery

• Readmission to hospital

  up to 30 days following surgery

• Healthcare related costs

  up to 52 weeks from date of surgery

Interventions

Shoulder arthroplasty PROCEDURE

Any form of joint replacement of the glenohumeral joint including prosthetic and excision.

Elbow arthroplasty PROCEDURE

Any form of joint replacement of the elbow joint including prosthetic and excision.

Hand and wrist arthroplasty PROCEDURE

Any form of joint replacement of joints of the hand and wrist including prosthetic and excision.

Nerve decompression PROCEDURE

Open or endoscopic release of peripheral nerve entrapment - subdivided by anatomical site of compression. Specific subgroups will include carpal tunnel and cubital tunnel release.

Tendon repair PROCEDURE

Open or arthroscopic repair or reconstruction of tendons of the shoulder, hand and upper limb in general.

Joint stabilisation PROCEDURE

Any procedure designed to increase stability of a joint, including soft tissue and bony blocking procedures.

Excision/division/release of palmar fascia PROCEDURE

Any procedure performed for treatment of Dupuytren's contracture.

Surgical fixation of fractures PROCEDURE

Any internal or external fixation of upper limb fractures - analysed by anatomical site.

Soft tissue release/debridement/excision PROCEDURE

Any removal or release of soft tissue for treatment of stiffness, functional impairment or pain. Specific subgroups will include trigger finger release, subacromial surgery and surgery for frozen shoulder.

Intra-articular injection PROCEDURE

Any intra-articular injection

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients undergoing treatment funded by or in NHS hospitals in England and recorded in the Hospital Episode Statistics Admitted Patient Care database.

You may qualify if:

• Condition affecting one of:
• Shoulder
• Elbow
• Wrist
• Hand
• AND
• All patients treated with surgery for any of the following:
• Osteoarthritis
• Inflammatory arthritis
• Any other cause of arthropathy
• Tendon tears
• Peripheral neuropathy
• Fractures and/or dislocations
• Instability
• Any arthroplasty surgery using a prosthesis

You may not qualify if:

• Patients registering a "type 2 opt out" - withholding NHS data from research use.

Sponsors & Collaborators

• University of Oxford: lead
• Wellcome Trust: collaborator
• National Institute for Health Research, United Kingdom: collaborator
• Arthritis Research UK: collaborator

Related Publications (6)

• Rees JL, Craig R, Nagra N, Baldwin M, Lane JCE, Price A, Beard DJ, Abram S, Judge A, Prieto-Alhambra D, Furniss D, Carr AJ. Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population based cohort study. BMJ. 2022 Jul 6;378:e069901. doi: 10.1136/bmj-2021-069901.

  PMID: 35938625 DERIVED

• Alser O, Abram SGF, Craig RS, Lane JCE, Shaw AV, Prats-Uribe A, Rees JL, Prieto-Alhambra D, Furniss D. Temporal Trends and Geographical Variation in Dupuytren Disease Surgery in England: A Population-Based Cohort Study. Ann Plast Surg. 2021 Sep 1;87(3):265-270. doi: 10.1097/SAP.0000000000002734.

  PMID: 34397515 DERIVED

• Lane JC, Craig R, Rees JL, Gardiner M, Mikhail MM, Riley N, Prieto-Alhambra D, Furniss D. Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: analysis of a national cohort of 43 076 surgeries. BMJ Open. 2021 Jul 7;11(7):e045614. doi: 10.1136/bmjopen-2020-045614.

  PMID: 34233971 DERIVED

• Lane JCE, Craig RS, Rees JL, Gardiner MD, Shaw AV, Spiteri M, Kuo R, Dean BF, Green J, Prieto-Alhambra D, Furniss D. Low rate of subsequent surgery and serious complications following intra-articular steroid injection for base of thumb osteoarthritis: national cohort analysis. Rheumatology (Oxford). 2021 Sep 1;60(9):4262-4271. doi: 10.1093/rheumatology/keaa925.

  PMID: 33410485 DERIVED

• Lane JCE, Craig RS, Rees JL, Gardiner MD, Green J, Prieto-Alhambra D, Furniss D. Serious postoperative complications and reoperation after carpal tunnel decompression surgery in England: a nationwide cohort analysis. Lancet Rheumatol. 2020 Sep 30;3(1):e49-e57. doi: 10.1016/S2665-9913(20)30238-1. eCollection 2021 Jan.

  PMID: 33381769 DERIVED

• Craig RS, Lane JCE, Carr AJ, Furniss D, Collins GS, Rees JL. Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population based cohort study using hospital episode statistics for England. BMJ. 2019 Feb 20;364:l298. doi: 10.1136/bmj.l298.

  PMID: 30786996 DERIVED

MeSH Terms

Conditions

Osteoarthritis; Joint Dislocations; Arthritis; Rotator Cuff Injuries; Shoulder Dislocation; Joint Diseases; Shoulder Fractures; Elbow Fractures; Wrist Fractures; Dupuytren Contracture; Shoulder Impingement Syndrome; Trigger Finger Disorder; Osteonecrosis

Interventions

Arthroplasty, Replacement, Shoulder; Arthroplasty, Replacement, Elbow; Injections, Intra-Articular

Condition Hierarchy (Ancestors)

Musculoskeletal Diseases; Rheumatic Diseases; Wounds and Injuries; Rupture; Shoulder Injuries; Tendon Injuries; Fractures, Bone; Elbow Injuries; Arm Injuries; Wrist Injuries; Fibroma; Neoplasms, Fibrous Tissue; Neoplasms, Connective Tissue; Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Contracture; Muscular Diseases; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Tendon Entrapment; Tendinopathy; Bone Diseases; Necrosis; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Arthroplasty, Replacement; Arthroplasty; Orthopedic Procedures; Surgical Procedures, Operative; Plastic Surgery Procedures; Prosthesis Implantation; Injections; Drug Administration Routes; Drug Therapy; Therapeutics

Study Officials

• Dominic Furniss, DPhil

  University of Oxford

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 4, 2018
• First Posted: June 29, 2018
• Study Start: April 6, 1998
• Primary Completion: April 5, 2017
• Study Completion: April 5, 2017
• Last Updated: June 29, 2018

Record last verified: 2018-06

Data Sharing

• IPD Sharing: Will not share