Targeted Muscle Reinnervation Does Not Increase the Risk of Postsurgical Complication or Overall Cost

Abstract

Background: Targeted muscle reinnervation (TMR) has shown promise in reducing postsurgical limb pain in amputees. However, there has been little evidence on the increased risk of complications and cost as compared with traditional amputations. This study was designed to assess the rate of complications and healthcare costs between those treated with TMR and traditional amputations. Methods: Patients undergoing amputation were selected from the PearlDiver Mariner dataset and categorized into one of two treatment groups depending on the use of TMR versus traditional amputation. Rates of postsurgical complications and overall healthcare costs were compared between the two groups, while controlling for differences in patient demographics and comorbidities. Results: One hundred sixteen TMR procedures and 76,412 traditional amputations were included in the study. The rate of complications did not differ between groups, with a complication rate of 77% in the TMR and 87% in the traditional amputation groups. Overall healthcare costs also did not differ 1 year after surgery, with an average cost of $32,632 in the TMR group and $36,219 in the traditional amputation group. Conclusions: Amputees experience high rates of postsurgical complications, morbidity, and mortality. However, there is no increased risk of complications or cost with the use of TMR. TMR has the potential benefits of reducing overall postsurgical pain and reestablishing activities of daily living. Although TMR is more expensive up front, it may reduce the overall healthcare costs by reducing the need for subsequent care. Further work is needed in large, randomized trials to examine these findings.

Optimizing Surgical Outcomes and the Role of Preventive Surgery: A Scoping Review

“…At institutions with greater microsurgery resources, it is possible that nearly all patients undergoing amputation may benefit from these techniques, especially given the favorable risk and cost profiles of these prophylactic procedures. 46,47 The Prevention of Lymphedema…”

“…techniques -especially given the favorable risk and cost profiles of these prophylactic procedures. 46,47 B. The Prevention of Lymphedema Complications and Costs:…”

“…Although preventive surgical techniques at the time of amputation, such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), may not be associated with significantly increased complications compared with amputation alone, they are associated with longer operative times, additional surgical sites, and increased cost. [46][47][48] For this reason, further clinical trials and more accurate risk assessment tools will be crucial to understand the efficacy of such prophylactic microsurgical procedures.…”