Epidemiology and Outcomes of Upper Limb Surgery: Analysis of Routine Data
Epidemiology and Outcomes of Upper Limb Surgery: Analysis of Routine Data
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.
The investigators will conduct time series analyses, geospatial mapping and risk-factor
 association studies for both access to and outcomes of surgical treatments of the upper
 limbs. A large cohort of pseudonymised records will be extracted from the NHS Hospital
 Episode Statistics Admitted Patient Care database. Suitable patients will be identified based
 on a match to a specified list of International Classification of Diseases (ICD-10) and
 Office for Population Censuses and Surveys (OPCS-4) codes. Dates and cause of death will be
 linked from the Office for National Statistics (ONS) by NHS Digital.

 Separate analyses will be conducted for different intervention types with detailed outcomes
 reporting for high volume procedures. Adults will be defined as those aged 18 years or older
 at the time of surgery. Children will be defined as those aged less than 18 years at surgery
 and only included in a limited number of analyses where relevant (e.g. trigger digit).

 Key analyses:

 1. Baseline demographics by procedure type

 2. Procedure volume incidence trends

 -  Time series analysis

 -  Adjusted to standard population distributions

 -  Geographical mapping including adjustment for sociodemographic indices including
 indices of deprivation

 3. Revision, reoperation and mortality rates:

 -  Estimation by Kaplan Meier and actuarial life table methods

 -  Life time risk calculated by the cumulative probability method

 -  Cox regression adjusted for comorbidities and demographic, social and geographic
 factors

 4. Complications, length of stay, costs:

 -  Logistic and linear regression models for binary and continuous outcomes
 respectively

 -  Adjusted for comorbidities and demographic, social and geographic factors

 Where appropriate, the impact of replacing missing data will be explored with use of multiple
 imputation. All suitable patients will be entered into analyses to maximise statistical
 efficiency.
Inclusion Criteria:

 1. Condition affecting one of:

 -  Shoulder

 -  Elbow

 -  Wrist

 -  Hand

 AND

 2. 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

 OR

 3. Any arthroplasty surgery using a prosthesis

 Exclusion Criteria:

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