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American Association for Hand Surgery

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Impact of socioeconomic factors in outpatient peripheral nerve reconstruction
Jed Ian Maslow, MD and Jonathon Savakus, M.D., Vanderbilt University Medical Center, Nashville, TN

Introduction
Peripheral nerve injuries (PNI) can be devastating due to poor functional recovery. Young males are the most commonly affected by PNI and treatment, time-off work, and long-term disability represent significant cost to patient and society. When PNI is segmental, delayed in presentation, or involves a large segment that cannot be primarily repaired, nerve autograft or allograft may be indicated and outcomes are generally considered worse. Several factors may influence whether an autograft or allograft is selected, including the type of nerve injured, injury characteristics, size of gap, and surgeon preference. Historically nerve autograft has been considered the gold standard for nerve reconstruction although recent data suggest allograft may be comparable to autograft. Although nerve autograft requires more surgical time to harvest and prepare, nerve allograft can be costly to use and maintain. The purpose of this study was to determine if socioeconomic factors influence the utilization of nerve allograft or autograft in ambulatory surgery centers.
Materials & Methods
Analysis of the Healthcare Cost and Utilization Project National Ambulatory Surgery Sample for the year 2018 was performed and patients who underwent nerve reconstruction with nerve allograft or autograft were identified based on current procedural terminology (CPT) codes. Univariate analysis was performed with Pearson chi-square test, Fisher's exact test, or Kruskal-Wallis H test where appropriate. Multivariate logistic regression was performed.
Results
Overall, 5,082 patients were analyzed who had nerve reconstruction performed with allograft or autograft at an ambulatory surgery center. A total of 537 (10.6%) patients underwent nerve reconstruction with nerve autograft and 4,543 (89.4%) patients underwent nerve reconstruction with nerve allograft. Females (p<0.01) and patients younger than 33 (p<0.01) or older than 50 (p<0.03) were more likely to receive nerve allograft than autograft. Hospitals in the Midwest (p=0.04) and those that are urban, teaching hospitals (p<0.01) are more likely to use autograft over allograft. There appeared to be no significant influence of patient insurance type, income, or hospital ownership on the type of nerve graft used.
Conclusions
There appear to be gender and geographic disparities in the selection of nerve autograft or allograft in the ambulatory surgery setting, though limited socioeconomic influences.


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