A Comparison Study of Major and Minor Complications After Inpatient Versus Outpatient Pediatric Brachial Plexus Surgery: A Preliminary Report.

BACKGROUND

Interest in outpatient surgery has grown secondary to emphasis on the delivery of efficient, high-quality care. This study sought to compare 90-day complications between pediatric patients undergoing outpatient versus inpatient brachial plexus nerve surgery.

METHODS

A single institution database was queried for primary exploration and treatment of brachial plexus birth injuries from 2011 to 2022. Standard demographic data and the American Society of Anesthesiologists (ASA) classification were recorded. Operative procedures included neurolysis, nerve transfers, and/or nerve grafting. Outcome measures included operative time, postoperative emergency department (ED) visits, unplanned readmissions, and reoperation within 90 days.

RESULTS

The query yielded 19 patients. The mean age in the outpatient cohort was 7.1 months, and 5.9 months in the inpatient cohort. All patients were ASA I or II. The nerve injury levels, based on physical examination and intraoperative findings, revealed more global injuries in the inpatient group ( P = 0.182). There was a significant difference ( P = 0.001) in procedure length, with an average of 174.9 minutes for the outpatient cohort compared with 279.3 minutes for the inpatient cohort. This represents more extensive reconstructive surgery with concomitant nerve transfers and nerve grafting required for the inpatient group. There were zero unplanned readmissions or reoperations. When comparing surgeries performed from 2011 to 2016 to those performed from 2017 to 2022, inpatient admission odds decreased by 92% (OR: 0.08, P = 0.045). Those who represented the ED had 3 times the odds of inpatient care compared with those with no ED representation (OR: 3.43, P = 0.33). There were 3 ED visits in the inpatient cohort. Two patients presented due to minor parental incisional concerns that required no further management. The ED visit in the outpatient cohort was due to an unrelated fever.

CONCLUSIONS

Over time, criteria were established to guide decision-making as more surgeries were safely conducted outpatient with no difference in complications. In appropriately selected patients, such as those of ASA I and II status, outpatient brachial plexus surgery may be safe and considered value-based care.

LEVEL OF EVIDENCE

Level III-retrospective cohort, nerve transfer, muscle transfer.