Drexelius Katherine D, Saltzman Eliana B, Bonvillain Kirby W, Mastracci Julia C, Gachigi Kennedy K, Lewis Daniel R, Waters Peter M, Loeffler Bryan J, Gaston R Glenn
Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
J Hand Microsurg. 2024 Sep 28;17(1):100164. doi: 10.1016/j.jham.2024.100164. eCollection 2025 Jan.
Outpatient orthopedic surgery is becoming more common as a method of providing safe and cost-effective medical care. The purpose of this study was to compare outcomes between adult patients undergoing outpatient versus inpatient brachial plexus surgery.
A single institution database was queried for patients with brachial plexus injuries undergoing brachial plexus exploration with or without concomitant reconstructive procedures from 2010 to 2022. Outcome measures included 90-day major and minor complications, as well as longer term pain scores and reoperation rates. Multivariate analysis was performed to compare outcomes between the cohorts.
In a group of 51 adult patients, 36 (70.6 %) were admitted for at least one night following surgery and 15 (29.4 %) underwent outpatient surgery. The cohorts were similar with respect to demographics. When compared to brachial plexus procedures performed between 2010 and 2016, those performed between 2017 and 2022 were 67 % more likely to be outpatient (OR 0.33; p = 0.11). The overall major complication rate during the 90-day episode of care was 11.8 % (n = 6), all of which occurred in the inpatient cohort There was no significant difference in minor complication rate. 90-day reoperation rate due to complications was 2.8 % in the inpatient cohort and 0.0 % in the outpatient cohort.
No prior study has assessed the safety of brachial plexus exploration and reconstruction in an outpatient setting. This study demonstrates that outpatient brachial plexus surgery is a safe option for properly selected patients. Procedures were more often performed outpatient in recent years, reflecting a continuing evolution of our practice.
门诊骨科手术作为一种提供安全且具成本效益的医疗护理方式正变得愈发普遍。本研究的目的是比较接受门诊与住院臂丛神经手术的成年患者的治疗结果。
查询单一机构数据库中2010年至2022年接受臂丛神经探查且伴有或不伴有同期重建手术的臂丛神经损伤患者。结果指标包括90天内的严重和轻微并发症，以及长期疼痛评分和再次手术率。进行多变量分析以比较两组患者的治疗结果。
在一组51例成年患者中，36例（70.6%）术后至少住院一晚，15例（29.4%）接受门诊手术。两组患者在人口统计学特征方面相似。与2010年至2016年进行的臂丛神经手术相比，2017年至2022年进行的手术门诊手术的可能性高67%（比值比0.33；p = 0.11）。90天护理期间的总体严重并发症发生率为11.8%（n = 6），均发生在住院患者队列中。轻微并发症发生率无显著差异。住院患者队列中因并发症导致的90天再次手术率为2.8%，门诊患者队列为0.0%。
此前尚无研究评估门诊环境下臂丛神经探查和重建的安全性。本研究表明，对于经过适当选择的患者，门诊臂丛神经手术是一种安全的选择。近年来门诊手术的实施更为频繁，反映了我们实践的持续演变。
