# Analysis of Surgical Procedures on the Forearm and Hand and Their Relationship with Complex Regional Pain Syndrome: A Cross-sectional Study

## TL;DR

This study found that patients with compressive syndromes and multiple incisions during forearm and hand surgeries are at higher risk of developing complex regional pain syndrome (CRPS) afterward.

## Contribution

The study identifies compressive syndromes and multiple incisions as novel risk factors for postoperative CRPS in forearm and hand surgeries.

## Key findings

- Patients with compressive syndromes, especially carpal tunnel syndrome, had twice the risk of developing CRPS.
- Two or more incisions during surgery tripled the chance of postoperative CRPS.
- Gender, age, synthetic material use, and anesthesia type did not significantly affect CRPS risk.

## Abstract

Objective
 Complex regional pain syndrome (CRPS) requires further understanding. Thus, the present study aimed to analyze if pre- and intraoperative factors may be related to the development of CRPS in the postoperative period.

Methods
 We reviewed 1,183 medical records of patients undergoing forearm and hand surgeries from 2015 to 2021. The data of interest, that is, diagnosis, incisions, synthesis material, and anesthesia, were collected, tabulated, and statistically analyzed, with subsequent calculation of the odds ratios.

Results
 Most patients were female, aged between 30 and 59 years, and sought the service electively (67% of the cases). The diagnoses included soft tissue trauma (43%), bone trauma (31.6%), and compressive syndromes (25.5%). During this period, 45 (3.8%) subjects developed CRPS. The statistical analysis showed that the chance of developing CRPS is twice as high in patients with compressive syndrome, especially carpal tunnel syndrome (CTS), which represented most surgeries performed in our service (24%). Two or more incisions occurred in 7.6% of the cases, which tripled the chance of developing postoperative CRPS. Gender, age, use pf synthetic material, type of anesthesia type did not statistically increase the risk of developing postoperative CRPS.

Conclusion
 In short, the incidence of CRPS is low; however, it is critical to know and recognize the risk factors for prevention and active screening in the postoperative period.

Objetivo
 A síndrome da dor regional complexa (SDRC) precisa ser mais bem compreendida. Assim, este estudo objetiva analisar se fatores pré e intraoperatórios poderiam estar relacionados ao desenvolvimento de SDRC no pós-operatório.

Métodos
 Foram revisados 1.183 prontuários de pacientes submetidos a cirurgias no antebraço e na mão entre 2015 e 2021. Os dados de interesse, como diagnóstico, incisões, material de síntese e anestesia realizada, foram coletados, tabulados e submetidos a testes estatísticos com posterior cálculo da razão de chances.

Resultados
 A maioria dos pacientes era do gênero feminino, com idade entre 30 e 59 anos, que buscaram o serviço de forma eletiva (67% dos casos). Os diagnósticos agrupados de forma geral foram: traumas de partes moles (43%), traumas ósseos (31,6%) e síndromes compressivas (25,5%). Durante esse período, 45 pacientes (3,8%) evoluíram com SDRC. A análise estatística mostrou que a chance de desenvolver SDRC é duas vezes maior em pacientes com síndrome compressiva, especialmente a síndrome do túnel do carpo (STC), que representou a maioria dos cirurgias realizadas em nosso serviço (24%). Em 7,6% dos casos, foram realizadas duas ou mais incisões, o que triplicou a possibilidade de SDRC pós-operatória. Gênero, idade, uso de material de síntese, ou tipo de anestesia não aumentaram estatisticamente o risco de SDRC no pós-operatório.

Conclusão
 Em suma, a incidência de SDRC é baixa, mas é importante conhecer e reconhecer os fatores de risco para a prevenção e a busca ativa no pós-operatório.