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Socioeconomic Disparities in Brachial Plexus Surgery

A National Database Analysis

Bucknor, Alexandra, MBBS, MSc*; Huang, Anne, BSc*; Wu, Winona, BA*; Fleishman, Aaron, MPH; Egeler, Sabine, MD*; Chattha, Anmol, BA*; Lin, Samuel J., MD, MBA*; Iorio, Matthew L., MD

Plastic and Reconstructive Surgery – Global Open: February 5, 2019 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000002118
Latest Articles: PDF Only

Background: Brachial plexus injuries have devastating effects on upper extremity function, with significant pain, psychosocial stress, and reduced quality of life. The aim of this study is to identify socioeconomic disparities in the receipt of brachial plexus repair in the emergent versus elective setting, and in the use of supported services on discharge.

Methods: Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample Database was performed for the years 2009–2014. Adults with brachial plexus injury with or without nerve repair were identified; patient and hospital specific factors were analyzed.

Results: Overall, 6,618 cases of emergent brachial plexus injury were retrieved. Six hundred sixty cases of brachial plexus repair were identified in the emergency and elective settings over the study period. Of the 6,618 injured, 153 (2.3%) underwent nerve surgery during the admission. Patients undergoing repair in the elective setting were more likely to be white males with private insurance. Patients treated in the emergency setting were more likely to be African American and in the lowest income quartile. Significant differences were also seen in supported discharge: more likely males (P < 0.001), >55 years of age (P < 0.001), white (P < 0.001), with government-based insurance (P < 0.001).

Conclusions: There are significant disparities in the timing of brachial plexus surgery. These relate to timing rather than receipt of nerve repair; socioeconomically advantaged individuals with private insurance in the higher income quartiles are more likely to undergo surgery in the elective setting and have a supported discharge.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo.

Published online 5 February 2019.

Received for publication December 4, 2018; accepted December 5, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Matthew L. Iorio, MD, Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical CenterMail Stop C309, 12631 East 17th Ave, Room 6619, Aurora, CO 80045, E-mail: matt.iorio@ucdenver.edu

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.