A Nationwide Analysis of Complications, Reoperations, and Cost of Wide-Awake Flexor Tendon Repairs.

Background: Some articles suggest that wide-awake flexor tendon repair (FTR) may reduce rates of postoperative tendon gapping and rupture because of improved intraoperative testing of the repair. The current study is a nationwide cohort study comparing FTRs performed wide-awake and with traditional anesthesia.

Methods: Patients undergoing zone II FTR between 2010 and 2022 were identified in PearlDiver. Exclusion criteria were other tendon repairs, concomitant treatment for vascular injury, fracture, dislocation or amputation, inpatient or office surgery, age younger than 18 years, and less than 1 year of follow-up. Patients were stratified by anesthesia technique: traditional anesthesia (general anesthesia, monitored anesthesia care, regional blocks) or wide-awake anesthesia. Patients were matched based on age, sex, Elixhauser Comorbidity Index score, geographic region, insurance coverage, number of tendon repairs, and presence of concomitant nerve repair. Thirty-day wound complications, emergency department visits and readmissions, and 1-year reoperations were identified. Total reimbursement for surgery was determined.

Results: Each matched cohort included 2563 patients. Wide-awake patients had fewer 30-day emergency department visits (2.7% versus 4.8%). There were no differences in 30-day wound complications or readmissions. There was no difference in 1-year reoperations for rupture or stiffness. Multivariable linear regression identified wide-awake surgery to be significantly associated with lower total reimbursement.

Conclusion: Performing digital FTR using wide-awake techniques can reduce costs, but the hypothesis that wide-awake repairs may reduce rates of tendon rupture was not supported by the current study.

Clinical question/level of evidence: Therapeutic, III.