Martin Enrico, Muskens Ivo S, Senders Joeky T, Cote David J, Smith Timothy R, Broekman Marike L D
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Computational Neurosciences Outcomes Center, Boston, Massachusetts 02115.
Department of Neurosurgery, Brain Center Rudulf Magnus, University Medical Center Utrecht, The Netherlands.
Microsurgery. 2019 Feb;39(2):115-123. doi: 10.1002/micr.30330. Epub 2018 Apr 15.
Little is known on adverse events and their timing after peripheral nerve surgery in extremities. The aim of this study is to identify predictors and typical timing of complications, unplanned readmission, and length of hospital stay for patients undergoing peripheral nerve surgery in the extremities.
Data were extracted from the National Surgical Quality Improvement Program (NSQIP) registry from 2005 to 2015. Adult patients undergoing peripheral nerve surgery in the extremities were included. A subgroup analysis was performed for brachial plexus operations. Multivariable logistic regression was performed to identify predictors of any complication, surgical site infection, unplanned readmission, and reoperation.
A total of 2,840 patients were identified; 628 were brachial plexus operations. Overall complications were 4.4% and 7.0%, respectively. Median time for occurrence of any complication was 8 days. The most common complications were wound-related (1.7%), which occurred at a median of 15 days postoperatively. Reoperation occurred in 1.8% of all cases; most commonly for musculoskeletal repair (16.7%). Unplanned readmissions occurred in 2.3% and were most often due to wound-related problems (24.1%). Preoperatively contaminated wounds, inpatient procedures, and longer operative time seemed to have the most influence on all adverse events. In brachial plexus pathology, insulin-dependent diabetes and emergency cases also negatively affected outcomes.
Complications usually occur one to two weeks postoperatively. Preoperatively contaminated wounds, inpatient procedures, and longer operative times influence outcome. Anatomical level of operation results in significantly different lengths of hospital stay; brachial plexus pathology has the longest length of stay.
关于肢体周围神经手术后的不良事件及其发生时间，人们了解甚少。本研究的目的是确定接受肢体周围神经手术患者并发症、计划外再入院和住院时间的预测因素及典型时间。
数据取自2005年至2015年的国家外科质量改进计划（NSQIP）登记处。纳入接受肢体周围神经手术的成年患者。对臂丛神经手术进行亚组分析。进行多变量逻辑回归以确定任何并发症、手术部位感染、计划外再入院和再次手术的预测因素。
共确定2840例患者；其中628例为臂丛神经手术。总体并发症发生率分别为4.4%和7.0%。发生任何并发症的中位时间为8天。最常见的并发症与伤口相关（1.7%），发生在术后中位时间15天。所有病例中1.8%进行了再次手术；最常见的是肌肉骨骼修复（16.7%）。计划外再入院率为2.3%，最常见原因是伤口相关问题（24.1%）。术前污染伤口、住院手术和较长手术时间似乎对所有不良事件影响最大。在臂丛神经病变中，胰岛素依赖型糖尿病和急诊病例也对结果产生负面影响。
并发症通常发生在术后一至两周。术前污染伤口、住院手术和较长手术时间影响结果。手术的解剖水平导致住院时间显著不同；臂丛神经病变住院时间最长。
