Introduction: Complication rates after peripheral nerve surgery, and factors that contribute to their development remain to be investigated. The National Surgical Quality Improvement Program (NSQIP) registry collects 30-day postoperative data and accommodates such research.
Methods: Data were extracted from NSQIP from 2005 to 2015. Patients with CPT codes specific for peripheral nerve surgery in extremities were included. Subgroup analysis was performed for brachial plexus operations. Multivariable logistic regression was used to evaluate independent predictors of any complication, surgical site infection (SSI), readmission, and reoperation.
Results: 2840 patients were identified; 628 were brachial plexus operations. Complications occurred in 4.4% and 7.0%, respectively, at a median time 8 days postoperatively. The most common complications were wound-related (1.7%), occurring after a median of 15 days. Predictors for complication included ASA classification III-V, inpatient procedures and longer operative times (>150 minutes). BMI >35 kg/m2, preoperative wound contamination, and longer operative time (>150 minutes) were associated with SSI. Age 51-65 years, preoperative wound complications, and inpatient procedures predicted reoperation. Only inpatient procedures were associated with readmission. Reoperation occurred in 1.8% of patients, the most common reasons for which were musculoskeletal repair (16.7%), lymphatic repair (16.7%), drainage of abscess or hematoma (16.7%), and wound-related problems (13.3%) (Figure 1). Readmissions occurred in 2.3% of patients, the most common reasons for which were wound-related (24.1%), pain (24.1%) and respiratory problems (10.3%). In brachial plexus surgery, insulin-dependent diabetes, inpatient procedures, and emergency cases predicted any complication. Length of hospital stay was significantly shorter in operations performed more distally, with brachial plexus pathologies having the longest hospital stay (Figure 2).
Conclusions: Peripheral nerve surgery in extremities results in low rates of complication, but wound-related complications are most common. Preoperative wound complications, inpatient procedures, and longer operative times tend to predict adverse events. Complications generally occur after discharge, at a median of 8 days postoperatively.
Patient Care: With increasing interest in cost-effectiveness and postoperative quality of life, understanding the prevalence and risk factors for adverse events after peripheral nerve surgery is increasingly important. The results of our study could serve as a basis on which health care practitioners can provide safe and effective postoperative management for patients undergoing extremity peripheral nerve operations, both before and after hospital discharge.
Learning Objectives: - Know rates for 30-day complications, readmission, reoperation, and length of hospital stay
- Identify common reasons for readmission and reoperation after peripheral nerve surgery
- Identify risk factors for short-term adverse events in patients undergoing peripheral nerve surgery