A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery

Abstract

Purpose Despite the importance of timely evaluation for patients with brachial plexus injuries (BPI), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. Methods We used statewide administrative databases from Florida (2007–2013), New York (2008–2012) and North Carolina (2009–2010) to create a cohort of patients who underwent surgery for BPI (exploration, repair, neurolysis, grafting, or nerve transfer). Emergency department and inpatient records were used to determine the time interval between the injury and surgical treatment. The distances between the treating hospitals and between the patient’s home ZIP code and the surgical hospital were recorded. A multivariable logistic regression model was used to determine predictors for time from injury to surgery exceeding 365 days. Results Within the 222 patients in our cohort, the median time from injury to surgery was 7.6 months and exceeded 365 days in 29% of cases. Treatment at a smaller hospital for the initial injury was significantly associated with surgery beyond 365 days after injury. Patient insurance type, travel distance for surgery, the distance between the two treating hospitals, or changing hospitals between injury and surgery did not significantly influence time to surgery. Conclusions Nearly one-third of patients in FL, NY, and NC underwent BPI surgery more than one year after their injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery. Clinical Relevance These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers.

A Population-Based Assessment of Depression and Anxiety in Patients With Brachial Plexus Injuries

“…Thus, uninsured patients, government-insured patients, and those patients with claims covered by automotive insurance, who may represent a substantial portion of BPI patients, were not included in this study. A prior study using administrative data reported that 47% of BPI patients have private insurance 34 ; our exclusion of BPI patients without private insurance limits the generalizability of our findings to all BPI patients. While it would be ideal to examine claims from an all-payer database, currently-available national datasets (such as those from Health Care Utilization Project [HCUP] and Agency for Healthcare Research and Quality) are limited in their length of follow-up (National Inpatient Sample tracks only individual hospitalizations), states/years available (HCUP statewide databases are not available for all states and all years), and data type available (pharmacy claims are not available in other datasets).…”

Indirect Cost of Traumatic Brachial Plexus Injuries in the United States

“…Even after successful surgical reconstruction, many individuals do not return to the same occupation or return to work at all after a BPI [4][5][6] . Furthermore, there are inefficiencies in care delivery for patients with BPI in the U.S., which may compromise clinical outcomes given the time-sensitive nature of the injury 7 . Estimation of the costs associated with BPI from a societal perspective would support continued allocation of resources for clinical care and research, with the ultimate goal of optimizing return to work and improving quality of life after a BPI.…”

“…e80(7) TH E J O U R N A L O F B O N E & JOINT SURGERY d J B J S . O R G VOLUME 101-A d N U M B E R 16 d AUGUST 21, 2019INDIRECT COST O F TRAUMATIC BRACHIAL PLEXUS I N J U R I E S I N T H E U N I T E D S TAT E S…”

Trends in Nerve Transfer Procedures Among Board-Eligible Orthopedic Hand Surgeons

“…This process is similar to strategies previously employed when identifying patients undergoing surgery for brachial plexus injury from administrative data sources. 7 , 8 We included patients regardless of the number of additional CPT-4 codes associated with them. Associated diagnostic codes for each patient were reviewed but were not used for case inclusion criteria owing to concerns for accuracy.…”