Lower Socioeconomic Status is Correlated with Significant Delays in Pediatric Brachial Plexus Injury (pBPI) Surgery in the United States
Megan Rose Donnelly, MD1, Aura Elias, BS2, Gerardo Sanchez-Navarro, BA1, Molly Stoner, BA1, Hilary Campbell, MD3, Rebecca Nicholas, MBBS, MSc, FRCS(Plast), Dip.Hand Surg.(Eu)1 and Jacques H. Hacquebord, MD1, 1NYU Langone Health, New York, NY, 2David Geffen School of Medicine at UCLA, Los Angeles, CA, 3New York University, New York, NY
Background: Earlier surgical interventions for pediatric brachial plexus injury (pBPI) are correlated with better postoperative outcomes. Unfortunately, however, it is often that the timing of these interventions is influenced by factors outside of clinical reasoning, such as access to care. The purpose of this study is to evaluate the role of socioeconomic factors in pBPI surgery care, primarily with regards to their influence on the timing of common nerve, muscle, and tendon procedures.
Methods: The Children’s Hospital Association’s Pediatric Health Information System (PHIS) Database was utilized to identify all patients <19 years of age at initial encounter with a diagnosis code for pBPI (ICD-10) entered into the system from 11/1/2015-2/28/2023. Only patients with CPT codes for nerve supplement, nerve excision, nerve repair, nerve transfer, muscle transfer, tendon transfer, and nerve release procedures were included, and patient demographics and perioperative information were extracted. Chi-Square testing and one-way ANOVA testing as well as bivariate and multivariate linear and logistic regression analyses were run to correlate socioeconomic factors with procedure timing.
Results: A total of 1,186 pBPI patients were included. In terms of procedure timing, the youngest patients were the ones who underwent nerve supplement, nerve excision, nerve repair and nerve transfer surgeries, while the oldest were the ones who underwent nerve release, tendon transfer and muscle transfer operations. Patient demographics, including lower household income, sex, race, insurance status, and neighborhood type (urban/suburban versus rural), varied significantly by procedure type. In multivariate regression, being below the median household income for all pBPI patients and white race were both correlated with increased age at the time of first procedure. Contrarily, government insurance was correlated with lesser delay to index documented pBPI surgery. For tendon transfer, underserved area was correlated with longer delay to procedure. Importantly, in this study, there was no correlation between socioeconomic factors and emergent/urgent versus elective procedure status.
Conclusions: Socioeconomically advantaged individuals have greater access to care, and, as this study demonstrates, greater access to pBPI surgeries without delay. Individuals with greater household income and government insurance are more likely to undergo pBPI surgery at a younger age whereas being in an underserved area, specifically for tendon transfer, were correlated with pBPI surgery delays. Additional research is needed to uncover further disparities that may exist in pBPI surgery and efforts should be made to ensure equitable delivery of these essential healthcare services to children across the United States.
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