Infectious Complications after Soft Tissue Surgery of the Hand in Patients with Chronic Kidney Disease

Background: The primary objective of this study is to understand postoperative infectious complication rates following soft tissue hand surgery in patients with chronic kidney disease (CKD). This study aims to assess whether patients with stage III–V CKD have an increased risk of superficial, deep or systemic infections compared with non-CKD patients.

Methods: A retrospective cohort study was conducted using the multi-centre TriNetX Research Network database, comparing adults with and without stage III–V CKD who underwent carpal tunnel release, trigger finger release, de Quervain’s release, ganglion cyst excision, palmar fasciectomy, synovectomy, tendon sheath excision or soft tissue excision of the hand. Patients with fracture- or dislocation-related procedures were excluded. Outcomes of interest included postoperative infection, skin/subcutaneous infection, osteomyelitis and sepsis assessed at 30- and 90-day intervals postoperatively. Propensity score matching was controlled for age, sex, race, obesity, diabetes, nicotine and alcohol dependence and malnutrition.

Results: After matching, 91,570 patients (45,785 per cohort) were analysed. At both 30 and 90 days postoperatively, CKD patients experienced higher rates of skin/subcutaneous infection, osteomyelitis and sepsis compared with non-CKD patients. Overall, postoperative infection rates were low but increased with greater CKD severity.

Conclusions: Stage III–V CKD is associated with an increased risk of deep and systemic infections following elective soft tissue hand procedures. While routine perioperative antibiotics are not currently indicated, our findings support a risk-stratified approach that considers stage III–V CKD a potential indication for enhanced postoperative surveillance.

Level of Evidence: Level II (Prognostic/Risk)