Bonvillain Kirby W, Saltzman Eliana B, Mastracci Julia C, Drexelius Katherine D, Herman Andrew C, Gachigi Kennedy K, Loeffler Bryan J, Waters Peter M, Gaston Raymond Glenn
Atrium Health Musculoskeletal Institute.
OrthoCarolina Hand Center.
J Pediatr Orthop. 2025 Sep 1;45(8):e733-e737. doi: 10.1097/BPO.0000000000002979. Epub 2025 Jul 21.
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.
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.
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.
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 III-retrospective cohort, nerve transfer, muscle transfer.
由于强调提供高效、高质量的医疗服务，门诊手术的关注度有所提高。本研究旨在比较接受门诊与住院臂丛神经手术的儿科患者90天内的并发症情况。
查询单一机构数据库中2011年至2022年臂丛神经产伤的初次探查和治疗情况。记录标准人口统计学数据和美国麻醉医师协会（ASA）分级。手术操作包括神经松解术、神经移植和/或神经移植术。观察指标包括手术时间、术后急诊就诊次数、非计划再入院次数以及90天内的再次手术情况。
查询得到19例患者。门诊队列的平均年龄为7.1个月，住院队列的平均年龄为5.9个月。所有患者均为ASA I或II级。根据体格检查和术中发现，住院组的神经损伤程度更广泛（P = 0.182）。手术时长存在显著差异（P = 0.001），门诊队列平均为174.9分钟，而住院队列平均为279.3分钟。这表明住院组需要进行更广泛的重建手术，并伴有神经移植和神经移植术。无计划外再入院或再次手术情况。将2011年至2016年进行的手术与2017年至2022年进行的手术进行比较时，住院入院几率降低了92%（OR：0.08，P = 0.045）。有急诊就诊的患者住院治疗几率是无急诊就诊患者的3倍（OR：3.43，P = 0.33）。住院队列中有3次急诊就诊。2例患者因家长对切口的轻微担忧前来就诊，无需进一步处理。门诊队列中的急诊就诊是由于无关的发热。
随着时间的推移，随着越来越多的手术在门诊安全进行且并发症无差异，制定了指导决策的标准。在适当选择的患者中，如ASA I和II级患者，门诊臂丛神经手术可能是安全的，并可被视为基于价值的医疗服务。
III级——回顾性队列研究，神经移植，肌肉移植。
