Early Post-operative Complications Following Nerve Transfer in Persons with Tetraplegia
Peter Qi, MD, University of Toronto, Toronto, ON, Canada, Christine B Novak, PT, PhD, Toronto Western Hospital Hand Program, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada and Jana Dengler, MASc, MD, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Introduction
Restoring upper extremity function is an important rehabilitative goal for persons with cervical spinal cord injury (SCI). Motor nerve transfer has become an increasingly viable strategy for improving function in the upper extremity of persons with SCI. While restoration of UE function is important, knowledge of operative risk and complications is essential in this vulnerable population. This study evaluated the early post-operative complications following upper extremity nerve transfer in patients with SCI.
Material & Methods
Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database (2005 to 2018). Adults with an ICD-9/ICD-10 diagnosis of spinal cord injury, who underwent a peripheral nerve procedure were compared to those that underwent tenodesis, tendon transfer and/or joint stabilization procedures. Between-group comparisons were performed based on: demographics, co-morbidities, length of stay, and 30-day post-operative complications.
Results
There were few reported cases of nerve and tendon surgeries in persons with SCI: nerve (n=13) and tendon (n=41) reconstructions. There were no significant differences in demographics or co-morbidities. Mean age was 45 ± 15 years and 68% were male. The most common co-morbidities were smoking (n = 7; 13%), hypertension (n = 6; 11%), open wound (n = 5; 9%) and COPD (n = 4; 7%). The nerve transfer group was more likely to have an open wound pre-operatively (p = 0.049). Average hospital stay was 1.4 ± 1.7 for nerve transfer and 1.4 ± 4.0 for tendon transfer. The majority of procedures were performed as outpatient surgery (62% for nerve transfer; 68% for tendon transfer; p = 0.43) under general anaesthesia (92% nerve transfer, 76% tendon transfer; p = 0.20). The majority of cases were done by orthopedic surgeons (74%; 26% plastic surgeons). Post-operative morbidity was low; infection (n = 1), pulmonary embolism (n = 1), urinary tract infection (n = 3). No patients required a return to the OR within 30 days. There were no significant differences in complications or post-operative morbidity between nerve versus tendon transfers.
Conclusions
This study suggests that post-operative morbidity is low for both nerve and tendon transfer procedures performed in SCI. This is important information to guide patient and clinician decision making. Fear of surgery and the risk of complications has been identified as one of the barriers to wider utilization of upper extremity reconstructive surgery in SCI.
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