TY - JOUR
T1 - A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery
AU - Dy, Christopher J.
AU - Baty, Jack
AU - Saeed, Mohammed J.
AU - Olsen, Margaret A.
AU - Osei, Daniel A.
N1 - Funding Information:
This publication was made possible by Washington University Institute of Clinical and Translational Sciences Grant UL1 TR000448 (to C.J.D. and D.A.O.), Sub award KL2 TR000450 (DAO) from the NIH–National Center for Advancing Translational Sciences (NCATS), components of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The Center for Administrative Data Research is supported in part by Washington University Institute of Clinical and Translational Sciences Grant UL1 TR000448 from the NCATS of NIH , Grant R24 HS19455 through the Agency for Healthcare Research and Quality , and Grant KM1CA156708 through the National Cancer Institute at the NIH . This publication’s contents are solely the responsibility of the authors and do not necessarily represent the official view of NCATS, Agency for Healthcare Research and Quality, National Cancer Institute, or NIH.
Publisher Copyright:
© 2016 American Society for Surgery of the Hand
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Purpose 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. Clinical relevance These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers.
AB - Purpose 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. Clinical relevance These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers.
KW - Brachial plexus
KW - delay
KW - nerve surgery
KW - time to surgery
KW - travel
UR - http://www.scopus.com/inward/record.url?scp=84990862159&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2016.07.054
DO - 10.1016/j.jhsa.2016.07.054
M3 - Article
C2 - 27570225
AN - SCOPUS:84990862159
VL - 41
SP - 903-909.e3
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
SN - 0363-5023
IS - 9
ER -