Surgical treatment of chronic exertional compartment syndrome - A flash in the pan?

Abstract

Objective: To quantify the changes in incidence and procedural volume of elective fasciotomies for chronic exertional compartment syndrome (CECS) in New York State from 2010 to 2018, identifying key demographic and geographic contributors to these trends.

Design: Retrospective epidemiological study.

Method: The New York Statewide Planning and Research Cooperative System (SPARCS) was queried for patients who underwent outpatient fasciotomy procedures between January 1, 2010, and December 31, 2018 for CECS. Yearly outpatient fasciotomy volumes were the main outcome measures, and secondary measures included patient age, the year of surgery, hospital location, and hospital volume. In addition, a literature search of all primary literature on CECS during the study period was performed using PubMed, Cochrane, and Embase databases.

Results: An increased incidence in fasciotomies was identified between 2012 and 2015 compared to those years before and after. Following a steep rise peaking at more than 700 cases in 2013 from an initial incidence of 320 cases in 2010, the number of outpatient fasciotomies has continued to decrease. Additionally, the rise and fall of fasciotomy procedures over this period appears to have been driven predominantly by procedures performed at higher-volume facilities, and in patients greater than 45 years old. High-volume facilities were geographically located near large metropolitan areas. Primary publications on CECS followed a similar trend to the incidence of fasciotomies.

Conclusions: Popularity of fasciotomies for CECS was transient, driven by more procedures in older patients and high-volume facilities in urban areas. Publication trends and literature targeted at older populations may have influenced procedural incidence.

Keywords: CECS; Chronic exertional compartment syndrome; Fasciotomy; SPARCS.