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Real Time Reporting of Iatrogenic Nerve Injuries in a Prospective QA Database at a Level I Trauma Center
Jens Hahnhaussen, MD; Philip Stahel; Kyros Ipaktchi
Denver Health Medical Center, Denver, CO,
Background: Iatrogenic nerve injury is a feared surgical complication. Patient morbidity and adverse outcomes strain patient physician relationship and often result in litigation. Despite the obvious importance to analyze iatrogenic nerve injuries there exists only limited prospective single center data on this pathology. We report the incidence of iatrogenic nerve injuries, leading to postoperative motor deficits, their anatomic distribution and the index procedure.
Methods: Retrospective analysis of prospectively collected iatrogenic nerve injuries in a morbidity and mortality - QA - database of one level 1 trauma center. Study period June 2007 to May 2011. Inclusion criteria: postoperative documentation of a new onset motor deficit. Exclusion criteria: pure sensory defects, incomplete chart documentation. Results: 46 patients (50 nerve injuries) out of 55 patients met inclusion criteria. Mean follow up was 5 months (range 0- 22 months), 9 patients with 9 nerve injuries were lost for follow up. Peroneal (22) and radial (10) nerves were most commonly injured. Iatrogenic nerve injuries were most commonly seen after fixation of humerus shaft and the supracondylar humerus (10), total knee arthroplasty (7), tibial nailing and fixation of the tibial plateau (6) and fixation of acetabular fractures (6). The overall incidence of new onset postoperative motor nerve palsy was 0.3% of all cumulative surgical cases in the study period.
Conclusion: Six index procedures accounted for majority of observed iatrogenic postoperative motor palsies in our study. The overall incidence of motor nerve palsies in our study is low; however this number only reflects inclusion of fully reported and documented motor defects. This study confirms the risk for iatrogenic nerve injuries during surgeries about the major joints. Iatrogenic nerve injuries must be reported, documented and disclosed to the patient. A transparent QA reporting process may help reduce incidence.
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