Predictors of Prolonged Hospitalization in Pyogenic Tenosynovitis of the Hand: A Retrospective Cohort Study Focused on Length of Stay

TL;DR

This study identifies patient factors like comorbidities and immunosuppression that predict longer hospital stays for hand infections requiring surgery.

Contribution

The study introduces a clinically meaningful threshold for prolonged hospitalization in hand septic tenosynovitis, focusing on patient vulnerability factors.

Findings

Comorbidities and immunosuppressive status were significantly associated with prolonged hospitalization.

Age, sex, time to presentation, and microbiological culture positivity were not linked to longer stays.

Patients had an average of 2.5 outpatient follow-up visits, indicating ongoing care needs after discharge.

Abstract

Background and Objectives: Septic tenosynovitis of the hand remains a surgical emergency associated with significant morbidity and healthcare resource utilization. While prior studies have focused primarily on diagnostic features, microbiology, and functional outcomes, factors influencing prolonged hospitalization remain insufficiently characterized. Length of stay (LOS) represents a pragmatic, patient- and system-centered outcome that may reflect disease burden and treatment complexity. To identify clinical, demographic, and treatment-related factors associated with prolonged hospitalization in patients treated surgically for septic tenosynovitis of the hand, using LOS ≥ 6 days as a clinically meaningful threshold. Materials and methods: A retrospective cross-sectional study was conducted including 38 adult patients treated surgically for acute septic tenosynovitis of the hand at a tertiary referral center between 1 January 2020 and 31 December 2024. Demographic variables, comorbidities, immunosuppressive status, mechanism of injury, anatomical involvement, time to presentation, microbiological findings, number of surgical procedures, inpatient LOS, and outpatient follow-up visits were analyzed. Results: The mean age was 53.2 ± 15.8 years, and the mean LOS was 7.5 ± 3.7 days (range, 2–17 days). Twenty-seven patients (71.1%) experienced an LOS ≥ 6 days. The presence of comorbidities (p = 0.0026) and immunosuppressive status (p = 0.0378) were significantly associated with prolonged hospitalization. In contrast, age, sex, time to presentation, and microbiological culture positivity, were not significantly associated with prolonged LOS. The mean number of outpatient follow-up visits was 2.5 ± 1.9, highlighting an additional post-discharge care burden. Conclusions: Prolonged hospitalization in septic tenosynovitis appears to be driven predominantly by patient-related vulnerability, particularly comorbidities and immunosuppression, rather than by anatomical involvement, microbiological profile, or presentation delay alone. LOS may serve as a useful surrogate marker for treatment burden and resource utilization, supporting early identification of high-risk patients and optimization of inpatient care pathways.

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