Complications

Complications were grouped into local (surgical site infection or dehiscence requiring surgery, and neurovascular or tendon injury) and systemic events (stroke, respiratory tract infection, acute myocardial infarction, venous thromboembolic disease, urinary tract infection and acute renal failure). All complications had to be registered within HES APC to be identified and therefore required at least day case admission or surgery; minor complications will therefore not be registered in the data set. Registered complications were defined within 30 and 90 days of surgery to align with NHS outcomes framework used to compare outcomes between different medical conditions.²⁹ Furthermore, in the NHS, all surgical activity is compared with regards to outcomes within 30 and 90 days, and therefore exploring SAEs that occur within this time frame enables comparison to other musculoskeletal conditions and limb surgeries, and to studies already published in the literature.^16–18 It was also our clinical experience that these serious local and systemic complications requiring hospital admission were likely to present within these time periods. Registered serious systemic events were studied in addition to serious local complications due to concern about the side effects of general anaesthesia associated with upper limb procedures, and to enable comparison to rates registered following surgery for other musculoskeletal conditions.^{17 18}