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Thirty-Day Perioperative Adverse Outcomes Following Peripheral Nerve Surgery
Kejia Hu, MD
Massachusetts General Hospital, Boston, MA
Background: As the growth in peripheral nerve surgery volume, the demand for health care safety and cost effectiveness has increased in recent years. Given our limited understanding, we evaluated prospectively identified and randomly sampled patients who underwent peripheral nerve surgery from 2005 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program database.
Methods: We used bivariate testing and multivariate logistic regression analysis to identify patient- and surgery-related risk factors for postoperative complication and unplanned readmission in peripheral nerve surgery patients, and especially estimate the impact of nerve grafting procedure.
Results: Overall, 2351 patients underwent peripheral nerve surgery, 120 complications were identified in 100 patients (4.25%), 103 patients (4.38%) received nerve grafting. Thirty-one (1.95%) Of 1593 patients were unplanned readmitted. Nerve grafting procedures had no association with postoperative complications and unplanned readmission rates. Patients who experienced inpatient procedure (OR= 2.54, P<0.001), longer operative time (OR= 1.00, P<0.001) and had worse wound classifications (OR= 1.83, P<0.001) increased odds of postoperative complication. Inpatient procedure (OR= 2.74, P=0.014) and any complications (OR= 24.43, P<0.001) were significantly associated with unplanned readmission.
Conclusions: Our study confirms that peripheral nerve surgery and nerve graft procedure can safely be performed after the proper patient selection was made, and appropriate and timely surgery was executed. We also identified risks associated with perioperative adverse outcomes, these data may be used as an adjunct for risk stratification for patients being considered for peripheral nerve surgery, which allow better targeting of the most costly and harmful complications of preventive measures.
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