QS3: Practice Trends in Plastic Hand Surgery: An Evaluation of Cases in the ASPS TOPs Database

Purpose: Despite making up 20-25% of hand surgeons with subspecialty certification in the field, little data exists characterizing the clinical practice of hand surgery among plastic surgeons. This study sought to evaluate hand surgery cases in the national Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database. Methods: All hand procedures logged in the TOPS database between 2002 and 2016 were identified by 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 were logged during the 15-year period reviewed. Sixty-eight percent of procedures were classified as involving soft tissue only, and 22.7% involved only bone and/or joint. The most common procedure categories included: wound closure/coverage (15.8%), debridement/drainage (15.3%), nerve (13.2%), tendon (12.9%), and fracture/dislocation (12.9%). This category breakdown remained relatively stable over time. Evaluation of longitudinal trends identified an increase over time in procedures performed in the ambulatory and office-based settings and the use of local anesthetic, as well as a transition from the procedural surgeon providing anesthesia to the use of anesthesiologists and nurse anesthetists. The average patient ASA increased from 1.27 to 1.83. Conculsions: Plastic surgeons play an important role in the field of hand surgery, performing a large breadth of procedure types, which has remained stable over time. The trends in facility type and anesthesia characteristics have, however, varied.