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Incidence, Risk Factors, and Trends of Motor Peripheral Nerve Injury After Colorectal Surgery

Analysis of the National Surgical Quality Improvement Program Database

Al-Temimi, Mohammed H. M.D., M.P.H.; Chandrasekaran, Bindupriya M.D.; Phelan, Michael J. Ph.D.; Pigazzi, Alessio M.D., Ph.D.; Mills, Steven D. M.D.; Stamos, Michael J. M.D.; Carmichael, Joseph C. M.D.

Diseases of the Colon & Rectum: March 2017 - Volume 60 - Issue 3 - p 318–325
doi: 10.1097/DCR.0000000000000744
Original Contributions: Outcomes
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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.

DESIGN: 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.

SETTINGS: The study used a national database.

PATIENTS: Patients undergoing colorectal resection between 2005 and 2013 were included.

MAIN OUTCOME MEASURES: 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)).

LIMITATIONS: 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

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding Support: The institution of Drs Carmichael, Stamos, Pigazzi, and Mills received financial support from Ethicon and Medtronic for their participation as instructors in industry courses.

Financial Disclosures: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Los Angeles, California, April 30 to May 4, 2016.

Correspondence: Joseph C. Carmichael, M.D., 333 City Blvd West, Suite 850, Orange, CA 92868. E-mail:

© 2017 The American Society of Colon and Rectal Surgeons