title: Risk factors for revision surgery following isolated ulnar nerve release at the cubital tunnel: a study of 25,977 cases.
abstract: BACKGROUND
  The literature investigating risk factors for failure after decompression of the ulnar nerve at the elbow (cubital tunnel release [CuTR]) is limited. The purpose of this study was to identify risk factors for failure of isolated CuTR, defined as progression to subsequent ipsilateral revision surgery.
  
  
  METHODS
  The 100% Medicare Standard Analytic Files from 2005 to 2012 were queried for patients undergoing CuTR. Patients undergoing any concomitant procedures were excluded. A multivariate binomial logistic regression analysis was used to evaluate patient-related risk factors for ipsilateral revision surgery. Adjusted odds ratios (ORs) and 95% confidence intervals were calculated for each risk factor.
  
  
  RESULTS
  A total of 25,977 patients underwent primary CuTR, and 304 (1.4%) of those with ≥2 years of follow-up required revision surgery. Although the rate of primary procedures is on the rise (P = .002), the revision rate remains steady (P = .148). Significant, independent risk factors for revision surgery included age <65 years (OR, 1.5; P < .001), obesity (OR, 1.3; P = .022), morbid obesity (OR, 1.3; P = .044), tobacco use (OR, 2.0; P < .001), diabetes (OR, 1.3; P = .011), hyperlipidemia (OR, 1.2; P = .015), chronic liver disease (OR, 1.6; P = .001), chronic anemia (OR, 1.6; P = .001), and hypercoagulable disorder (OR, 2.1; P = .001).
  
  
  CONCLUSIONS
  The incidence of failure requiring ipsilateral revision surgery after CuTR remained steadily low (1.4%) during the study period. There are numerous patient-related risk factors that are independently associated with an increased risk for revision surgery, the most significant of which are tobacco use, younger age, hypercoagulable disorder, liver disease, and anemia.
authors.affiliation: Sports Medicine Center, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Camp
authors.affiliation: Weill Cornell Medical College, Cornell University, New York, NY, USA.
authors.forename: Claire B
authors.initials: CB
authors.lastname: Ryan
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Degen
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Altchek
authors.affiliation: Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: bcw4x@virginia.edu.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D002908:Chronic Disease; D020430:Cubital Tunnel Syndrome / Q000453:epidemiology* / Q000601:surgery*; D019299:Decompression, Surgical / Q000639:trends; D003920:Diabetes Mellitus / Q000453:epidemiology; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D015994:Incidence; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012307:Risk Factors; D019851:Thrombophilia / Q000453:epidemiology; D064424:Tobacco Use / Q000453:epidemiology; D014459:Ulnar Nerve / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Cubital tunnel syndrome; cubital tunnel release; elbow; revision surgery; ulnar nerve; ulnar nerve decompression