Citations

Background: Polydactyly surgery rates and trends are poorly characterized. The purpose of this study was to characterize national pediatric polydactyly management by examining operative and procedural trends over time, evaluating timing of treatment, identifying factors associated with interventions, and comparing costs and complications. Methods: We used the PearlDiver national administrative claims database to identify pediatric patients aged 18 and under with a diagnosis of polydactyly (2010-2023). We analyzed patients who received procedures coded as surgical correction or suture ligation, then characterized rates and factors associated with each intervention, and investigated postoperative complication rates. Results: Of 42 543 polydactyly patients, 3880 patients (9.1%) underwent surgery, and 5612 patients (13.2%) underwent procedures coded as suture ligation. Over the past decade, the incidence of polydactyly diagnosis and surgery has decreased, while rates of procedures coded as suture ligation have not changed significantly. In 2010, 12.0% of patients underwent surgery, compared to 7.3% in 2020. Patients of ages 1 to 2 years comprised the greatest proportion of the population who underwent surgical operations at 1729 patients (36.0%), and patients of ages 0 to 1 year comprised the greatest proportion of the population who underwent suture ligations at 3327 patients (51.0%) ( P < .001). Younger age at diagnosis and higher comorbidity index were associated with a greater likelihood of surgery, while greater mean family income was associated with a lower likelihood. Among treatment categories, surgery was associated with greater 1-year and total payer-reimbursed costs ( P < .05). Conclusions: We observed a declining incidence of pediatric polydactyly and polydactyly surgery. These findings may inform future guideline development and discourse for pediatric hand care.

This review article summarizes the basic principles of vascular anatomy, physiology, diagnostic work-up and treatment for patients with nontraumatic upper extremity vascular disorders. Vascular disorders can be considered vasospastic or occlusive. The most commonly encountered vasospastic condition is Raynaud’s Phenomenon secondary to scleroderma. While historically this has been managed medically with vasodilators, more advanced cases can benefit from surgical treatment to improve blood flow and minimize tissue loss, with compelling evidence that earlier surgical intervention can modify disease process and should be considered. Occlusive disease can present as aneurysm or thrombosis and often requires surgical treatment with resection of the occluded segment with or without vascular reconstruction. In advanced atherosclerotic disease or end stage ischemia, arterialization of the venous system can be considered to avoid more proximal amputations.