title: Thirty-Day Perioperative Adverse Outcomes After Peripheral Nerve Surgery: An Analysis of 2351 Patients in the American College of Surgeons National Surgical Quality Improvement Program Database.
abstract: BACKGROUND
  Because peripheral nerve surgery has become more common in recent years, the pressure to increase this procedure's health care safety and cost-effectiveness has increased. Given our limited understanding, we evaluated prospectively identified and randomly sampled patients who underwent peripheral nerve surgery from 2005 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program database.
  
  
  METHODS
  We used bivariate testing and multivariate logistic regression analysis to identify patient- and surgery-related risk factors for postoperative complications and unplanned readmission in peripheral nerve surgery patients, and especially to estimate the impact of the nerve grafting procedure.
  
  
  RESULTS
  Overall, 2351 patients underwent peripheral nerve surgery, 120 complications were identified in 100 patients (4.25%), and 103 patients (4.38%) received nerve grafting. Thirty-one of the 1593 patients (1.95%) underwent unplanned readmission. Nerve grafting procedures had no association with postoperative complications and unplanned readmission rates. Patients who experienced an inpatient procedure (odds ratio [OR], 2.54; P < 0.001), a longer operative time (OR, 1.00; P < 0.001), and worse wound classifications (OR, 1.83; P < 0.001) all had increased odds of postoperative complications. An inpatient procedure (OR, 2.74; P = 0.014) and any complications (OR, 24.43; P < 0.001) were significantly associated with unplanned readmission.
  
  
  CONCLUSIONS
  Our study confirms that peripheral nerve surgery and nerve graft procedures can be safely performed with low complication risks and low unplanned readmission rates. We also identified the risks associated with perioperative adverse outcomes, and these data may be used as an adjunct for risk stratification for patients under consideration for peripheral nerve surgery. This approach may enable the improved targeting of the most costly and harmful complications of preventive measures.
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kejia
authors.initials: K
authors.lastname: Hu
authors.affiliation: Department of Traditional Chinese Medicine, Jingan District Central Hospital, Fudan University, Shanghai, China.
authors.forename: Tiansong
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hutter
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: wendongxu@fudan.edu.cn.
authors.forename: Wendong
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: zwilliams@mgh.harvard.edu.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000401:mortality* / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010525:Peripheral Nerves / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: ACS NSQIP; Nerve grafting; Peripheral nerve surgery; Short-term complications; Unplanned readmission