BACKGROUND: Acute hand surgery at Christchurch Public Hospital is shared between the Plastic and Orthopaedic surgical departments. During the review, this tertiary level facility had four PRS trainee registrars and three non-training registrars. The focus was to review the operation types, when and who were performing them and a brief overview on complications.
METHOD: CDHB coding system was manually searched for acute hand operations performed from June to September 2018 by any member of the Plastic Surgery team. The electronic records (HCS) were cross-referenced for written follow-up and imaging correspondence. The review occurred four weeks after the final included operation. Hand burns and paediatric GA hand suture removal were excluded.
RESULTS: 223 operations were performed. 135 (60.5%) cases were undertaken by a PRS trainee as the primary operator with 64 (28.7%) cases led by a non-training registrar. 185 (82.9%) gained access to theatre within one day with over half of the cases (125, 56%) due to lacerations alongside infection and fractures as other presentations. There were roughly equal flexor and extensor injuries, 22 (9.9%) and 23 (10.3%) respectively. Digital nerves, muscle bellies, and radial arteries were also repaired. Most cases (82.5%) were performed during daytime hours (<5pm) with only 18 (8%) undertaken later than 9pm owing to clinical urgency or theatre availability. Using the Clavien-dindo system, there were 9 (4.0%) grade III and 5 (2.2%) grade II complications.
CONCLUSION: Hand surgery contributes a significant portion to the acute workload of the Plastic Surgery department at Christchurch Public Hospital. Access to operating theatres made completing 223 cases during this 4-month review period feasible with a Clavien-dindo grade II-III complication rate of 6.2%. A review limitation is that complications can occur outside a 4-week follow-up window and therefore further auditing/research would be valuable to explore long term outcomes within the department.