Congenital Upper Extremity Defects: USA National Incidence And Risk Factors
Hilliard T. Brydges, BS, Michael F. Cassidy, BA, Bachar F. Chaya, MD, David L. Tran, MD, Ogechukwu C. Onuh, BA, Matteo Laspro, BA, Arthur R. Celestin, MD, Sheel Sharma, MD.
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA.
PURPOSE: Identify maternal risk factors and social determinants of health related to congenital upper extremity (UE) defects and establish the American incidences rates.
METHODS: Deidentified and aggregated patient data was sourced from American institutions utilizing Epic CosmosTM. Social factors were analyzed using Center for Disease Control produced Social Vulnerability Index (SVI) data. Odds ratios and 95% confidence intervals were calculated for categorical variables and Cochrane-Armitage tests assessed for differences in trends of ordinal SVI data.
RESULTS: Querying over 166 million patient records, incidence rates and associations were established using cohorts of over 7 million and 5 million children respectively (Table 1). Overall incidence rate of all UE defects was found to be 55.8 per 10,000 live births, of which polydactyly was most common (35.5) followed by syndactyly (12.5). Worsening social factors were associated with all evaluated defects, however polydactyly demonstrated near ubiquitous association with evaluated SVI factors. 
CONCLUSIONS: This study examining the largest cohort of patients reported to date establishes the US incidences of these UE Defects. Further, these data demonstrate association between UE defects and various poor social determinants of health. Finally, these findings quantify risk factors associated with congenital UE defects.
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