Patient Characteristics Associated with Operative Treatment for Adult Traumatic Brachial Plexus Injuries at Two Tertiary Referral Hospitals in a Single US Metropolitan Area.

Abstract

Background: The primary objective of this study was to identify patient-related and socioeconomic factors associated with the operative treatment of adult traumatic brachial plexus injuries (BPI) at two tertiary referral centres in a single metropolitan area in the United States. The secondary objective was to assess surgeon variability in operative treatment. Methods: Adult patients with traumatic BPI at two tertiary referral centres in a single metropolitan area from 2015 to 2019 were retrospectively identified. After applying exclusion criteria, 84 adult patients with traumatic BPI treated by 22 surgeons were included. Our response variable was operative treatment of the traumatic BPI. Bi-variate screen was performed, and multi-variable logistic regression analysis was used to identify factors associated with operative treatment. Surgeon variability was separately assessed using Fisher's exact test. Results: The mean age of the study cohort was 45 years, and 69% were male. The most common BPI pattern was a global injury (39%) followed by an upper trunk injury (23%). Thirty-eight patients (45%) underwent operative treatment for the traumatic BPI. Multivariable logistic regression analysis showed that younger age and out-of-state referral were associated with operative treatment. There was significant surgeon variation in the utilisation of operative treatment. Conclusions: Out-of-state patients had more than four times higher odds of operative treatment, suggesting a regional practise pattern in which BPI requiring surgery are referred from surrounding states to our tertiary centres. Supra-regional BPI centres may facilitate timely referrals for specialty care. High-quality outcomes research in BPI is needed to mitigate surgeon treatment variation. Level of Evidence: Level IV (Therapeutic).