title: Predictors of surgical revision after in situ decompression of the ulnar nerve.
abstract: BACKGROUND
  This study was performed to identify factors associated with the need for revision surgery after in situ decompression of the ulnar nerve for cubital tunnel syndrome.
  
  
  METHODS
  This case-control investigation examined all patients treated at one institution with open in situ decompression for cubital tunnel syndrome between 2006 and 2011. The case patients were 44 failed decompressions that required revision, and the controls were 79 randomly selected patients treated with a single operation. Demographic data and disease-specific data were extracted from the medical records. The rate of revision surgery after in situ decompression was determined from our 5-year experience. A multivariate logistic regression model was used based on univariate testing to determine predictors of revision cubital tunnel surgery.
  
  
  RESULTS
  Revision surgery was required in 19% (44 of 231) of all in situ decompressions performed during the study period. Predictors of revision surgery included a history of elbow fracture or dislocation (odds ratio [OR], 7.1) and McGowan stage I disease (OR, 3.2). Concurrent surgery with in situ decompression was protective against revision surgery (OR, 0.19).
  
  
  CONCLUSIONS
  The rate of revision cubital tunnel surgery after in situ nerve decompression should be weighed against the benefits of a less invasive procedure compared with transposition. When considering in situ ulnar nerve decompression, prior elbow fracture as well as patients requesting surgery for mild clinically graded disease should be viewed as risk factors for revision surgery. Patient factors often considered relevant to surgical outcomes, including age, sex, body mass index, tobacco use, and diabetes status, were not associated with a greater likelihood of revision cubital tunnel surgery.
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors: Justin D
authors: JD
authors: Krogue
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors: Alexander W
authors: AW
authors: Aleem
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors: Daniel A
authors: DA
authors: Osei
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors: Charles A
authors: CA
authors: Goldfarb
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: calfeer@wudosis.wustl.edu.
authors: Ryan P
authors: RP
authors: Calfee
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D020430:Cubital Tunnel Syndrome / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D014459:Ulnar Nerve / Q000601:surgery*; D000092464:Elbow Injuries
keywords: Ulnar nerve; decompression; failure; surgical revision