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Economic Impact of Surgical Complications on Hospitals.

Discussion | Cubital tunnel syndrome is diagnosed by a combination of patient symptoms, physical examination findings, and nerve conduction studies. Patients present with reports of intermittent or persistent numbness or tingling in the ulnar nerve distribution distal to the elbow, often exacerbated by prolonged flexion of the elbow or direct pressure on the ulnar nerve. Long-term compression can result in loss of sensation in the small and ring fingers, weakness of grip, loss of coordination, and atrophy of the interosseous muscles. Nerve conduction studies objectively confirm the point of compression. Studies have failed to definitively support 1 method of decompression over the other.2 The open in situ method appears to be gaining traction as a favored procedure in clinical practice.3 The in situ method release decompresses the points of compression; however, the nerve is still under tension when the elbow is flexed.4 It is also at risk for symptomatic subluxation postoperatively. The concern for devascularizing the nerve during transposition has been addressed and does not appear to offer long-term morbidity.5 Transposition continues to be favored at our facility with a low rate of serious complications. None of 5 different methods of ulnar nerve decompression were found to have a statistically significant increased rate of local morbidity. Body mass index, diabetes, tourniquet time, and perioperative antibiotic use did not affect post operative local complications. Tobacco users had a statistically significant higher risk of local complications. The surgeons at our institution will continue to do the decompressive surgery they feel most appropriate for a particular patient, while emphasizing the benefits of nicotine cessation. Educational efforts will be focused toward emphasizing the anatomy of antebrachial cutaneous nerve branches.6