Incidence, Risk Factors, and Trends of Motor Peripheral Nerve Injury After Colorectal Surgery: Analysis of the National Surgical Quality Improvement Program Database.
BACKGROUND
Motor peripheral nerve injury is a rare but serious event after colorectal surgery, and a nationwide study of this complication is lacking.


OBJECTIVE
The purpose of this study was to report the incidence, trends, and risk factors of motor peripheral nerve injury during colorectal surgery.


METHODS
The National Surgical Quality Improvement Program database was surveyed for motor peripheral nerve injury complicating colorectal procedures. Risk factors for this complication were identified using logistic regression analysis.


METHODS
The study used a national database.


METHODS
Patients undergoing colorectal resection between 2005 and 2013 were included.


METHODS
The incidence, trends, and risk factors for motor peripheral nerve injury complicating colorectal procedures were measured.


RESULTS
We identified 186,936 colorectal cases, of which 50,470 (27%) were performed laparoscopically. Motor peripheral nerve injury occurred in 122 patients (0.065%). Injury rates declined over the study period, from 0.025% in 2006 to <0.010% in 2013 (p < 0.001). Patients with motor peripheral nerve injury were younger (mean ± SD; 54.02 ± 15.41 y vs 61.56 ± 15.95 y; p < 0.001), more likely to be obese (BMI ≥30; 43% vs 31%; p = 0.003), and more likely to have received radiotherapy (12.3% vs 4.7%; p < 0.001). Nerve injury was also associated with longer operative times (277.16 ± 169.79 min vs 176.69 ± 104.80 min; p < 0.001) and was less likely to be associated with laparoscopy (p = 0.043). Multivariate analysis revealed that increasing operative time was associated with nerve injury (OR = 1.04 (95% CI, 1.03-1.04)), whereas increasing age was associated with a protective effect (OR = 0.80 (95% CI, 0.71-0.90)).


CONCLUSIONS
This study was limited by its retrospective nature.


CONCLUSIONS
Motor peripheral nerve injury during colorectal procedures is uncommon (0.065%), and its rate declined significantly over the study period. Prolonged operative time is the strongest predictor of motor peripheral nerve injury during colorectal procedures. Instituting and documenting measures to prevent nerve injury is imperative; however, special attention to this complication is necessary when surgeons contemplate long colorectal procedures.
1 Department of General Surgery, Arrowhead Regional Medical Center, Colton, California 2 Department of General Surgery, Kaiser Permanente (Fontana) Medical Center, Fontana, California 3 Department of Biostatistics, University of California Irvine, Irvine, California 4 Division of Colon and Rectal Surgery, University of California, Irvine, Irvine, California.
Mohammed H
MH
Al-Temimi
Bindupriya
B
Chandrasekaran
Michael J
MJ
Phelan
Alessio
A
Pigazzi
Steven D
SD
Mills
Michael J
MJ
Stamos
Joseph C
JC
Carmichael
D000328:Adult; D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000453:epidemiology* / Q000209:etiology*; D058996:Quality Improvement; D012307:Risk Factors