Patient-Reported Quality of Life and the Impact of Delayed Referral to a Nerve Surgeon
John M Felder, MD, Washington University, St Louis, MO and Ivica Ducic, MD, PhD, Washington Nerve Institute, McLean, VA
Introduction: Little emphasis has been paid to characterize quality of life (QOL) burdens experienced by patients seeking treatment for nerve injuries.
Materials & Methods: A retrospective survey was distributed to all patients from a single nerve surgeon's practice between 2014 - 2020. Data collected included demographics, specifics of nerve injury/disorder type, reasons for and outcomes of surgery, time to referral, and experience finding appropriate treatment.
Results: 189 out of 767 patients responded (24.6%). Average age was 49 years, 70.1% male, 29.9% female. Notable comorbidities included anxiety (30.1%), depression (21%), thyroid disorders (11.3%). Prior to presentation, symptoms were present for: <3 months (3.2%), 3-6 months (9.6%), >6 months (87.2%). Severity of symptoms at presentation was reported to be: profound (84%), moderate (15.5%). Symptoms affected: sleep (78.6%), social life (85%), professional activities (65.8%), mood/spirits (75.9%). Symptoms affected QOL: significantly (82.4%), moderately 15%. Total number of physicians seen before presentation: 0 (1.6%), 1-3 (35.8%), 4-6 (37.4%), 7-10 (15.5%), 11-15 (5.3%), 16-20 (4.3%). 61% felt they should have been referred earlier. 48.4% were not told that nerve surgery was an option for their problem. 68.7% were told that nothing could be done.
Patients felt that nerve surgery helped symptoms: significantly (47.1%), moderately (23.5%), somewhat (12.8%), not helpful (16.6%). Nerve surgery positively affected: Sleep patterns (56.7%), extremity function (31.6%), Personal / social life (63.6%), Professional productivity (50.3%), mood (64.2%). Overall reported impact of nerve surgery on QOL was: significantly helpful (50.8%), moderately helpful (19.3%), somewhat helpful (13.4%), not helpful (15.5%). The average overall satisfaction with nerve surgery was 7.6/10; 41% rated 10/10.
76.8% felt that earlier referral would have improved their quality of life. 85.6% stated that if they could go back in time, they would have the surgery again.
Conclusions: The majority of patients reported that nerve injuries imparted a moderate to severe impact on their quality of life, and that treatment by a peripheral nerve surgeon improved their quality of life. The majority of patients experienced a delay in appropriate diagnosis and treatment (>6 months after onset) and felt that earlier referral would have improved their quality of life. Improved interdisciplinary coordination may be helpful in facilitating timely diagnosis and referral, and thus outcomes.
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