Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Surgery, Clinical Laboratory for the Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria.
PLoS One. 2020 Apr 6;15(4):e0229530. doi: 10.1371/journal.pone.0229530. eCollection 2020.
Peripheral nerve injury in the upper extremity is linked to high socioeconomic burden, yet cost-analyses are rare and from small cohorts. The objective of this study was to determine the costs and long-term socioeconomic effects of peripheral nerve injuries in the upper extremity in Germany.
We analyzed data of 250 patients with 268 work-related upper extremity nerve injuries from acute treatment to long-term follow-up on rehabilitation, sick-leave and disability-pension.
Patients were on average 39.9±14.2 years old, male (85%) and mean inpatient treatment was 7±6 days. Location of nerve was 8% (N = 19) proximal to the wrist, 26% (N = 65) at the wrist and metacarpus, and 66% (N = 166) at phalangeal level. Acute in-patient treatment for (single) median nerve injury accounted for 66% with hospital reimbursement of 3.570€, ulnar nerve injury for 24% and 2.650€ and radial nerve injury for 10% and 3.166€, all including finger nerve injuries. The remaining were combined nerve injuries, with significantly higher costs, especially if combined with tendon 5.086€ or vascular injury 4.886€. Based on location, nerve injuries proximal to the wrist averaged 5.360±6.429€, at the wrist and metacarpus 3.534±2.710€ and at the phalangeal level 3.418±3.330€. 16% required rehabilitation with average costs of 5.842€ and stay of 41±21 days. Sick leave was between 11-1109 days with an average of 147 days with socioeconomic costs of 197€/day, equaling on average 17.640€. 30% received a mean yearly disability pension of 3.187€, that would account to 102.167€ per lifetime.
This large German patient sample indicates that nerve injury has a major impact on function and employment, resulting in significant health care costs. Both proximal and distal nerve injuries led to long-term disability, subsequent sick-leave and in 30% to permanent disability pension. These data are determined to support future studies and health economical work on prevention, treatment and rehabilitation of these often small injuries with great consequences.
上肢周围神经损伤与高社会经济负担有关，但成本分析很少，且样本量较小。本研究的目的是确定在德国上肢周围神经损伤的成本和长期社会经济影响。
我们分析了 250 例 268 例与工作相关的上肢神经损伤患者的数据，这些患者从急性治疗到长期随访的康复、病假和残疾抚恤金。
患者平均年龄为 39.9±14.2 岁，男性（85%），平均住院治疗 7±6 天。神经位置为 8%（N=19）位于腕部近端，26%（N=65）位于腕部和掌骨，66%（N=166）位于指部。急性住院治疗（单一）正中神经损伤占 66%，医保报销 3.570 欧元，尺神经损伤占 24%，医保报销 2.650 欧元，桡神经损伤占 10%，医保报销 3.166 欧元，均包括指神经损伤。其余为合并神经损伤，费用明显更高，尤其是合并肌腱损伤 5.086 欧元或血管损伤 4.886 欧元时。根据位置，腕部近端神经损伤平均费用为 5.360±6.429 欧元，腕部和掌骨 3.534±2.710 欧元，指部 3.418±3.330 欧元。16%需要康复治疗，平均费用为 5.842 欧元，住院时间为 41±21 天。病假时间为 11-1109 天，平均 147 天，社会经济成本为 197 欧元/天，平均为 17640 欧元。30%的人每年平均领取残疾抚恤金 3187 欧元，终身残疾抚恤金为 102167 欧元。
这项来自德国的大型患者样本表明，神经损伤对功能和就业有重大影响，导致医疗保健费用显著增加。近端和远端神经损伤均导致长期残疾，随后病假，30%的人永久性残疾抚恤金。这些数据有助于支持未来关于这些经常发生但后果严重的小损伤的预防、治疗和康复的研究和健康经济学工作。
