title: A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery.
abstract: OBJECTIVE
  Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), 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. Distances between 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, median time from injury to surgery was 7.6 months and exceeded 365 days in 29% (64 of 222 patients) 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, distance between the 2 treating hospitals, and changing hospitals between injury and surgery did not significantly influence time to surgery.
  
  
  CONCLUSIONS
  Nearly one third of patients in Florida, New York, and North Carolina underwent BPI surgery more than 1 year after the injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery.
  
  
  CONCLUSIONS
  These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers.
authors: Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO. Electronic address: dyc@wudosis.wustl.edu.
authors: Christopher J
authors: CJ
authors: Dy
authors: Division of Biostatistics, Washington University School of Medicine, St Louis, MO.
authors: Jack
authors: J
authors: Baty
authors: Department of Medicine, Division of Infectious Diseases, Center for Administrative Data Research, Washington University School of Medicine, St Louis, MO.
authors: Mohammed J
authors: MJ
authors: Saeed
authors: Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO; Department of Medicine, Division of Infectious Diseases, Center for Administrative Data Research, Washington University School of Medicine, St Louis, MO.
authors: Margaret A
authors: MA
authors: Olsen
authors: Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO.
authors: Daniel A
authors: DA
authors: Osei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001917:Brachial Plexus / Q000293:injuries / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016208:Databases, Factual; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000592:standards / Q000706:statistics & numerical data*; D009518:New York / Q000453:epidemiology; D009657:North Carolina / Q000453:epidemiology; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors; D014195:Travel; D055815:Young Adult
keywords: Brachial plexus; delay; nerve surgery; time to surgery; travel