Nerve procedures added to amputation linked with lower costs, shorter hospital stay
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BOSTON — Health care system expenditures and patient satisfaction can be improved with the addition of nerve interventions to upper extremity amputations, according to a presenter.
“Nerve interventions with upper extremity amputation can decrease cost, as well as improve patient outcomes. Our average direct cost was statistically significantly lower in the amputation with nerve intervention group at every anatomic region,” Donna L. Mullner, MD, a plastic surgery resident at the Medical University of South Carolina, said at the American Society for Surgery of the Hand Annual Meeting.
Mullner presented results of one of the best papers at the meeting, which was an analysis of entries in a Vizient clinical database for a group of patients who underwent upper extremity amputations with nerve-related procedures and another group of patients who underwent upper extremity amputations alone from 2018 to 2022. Patients were then subcategorized by the anatomic location of amputation.
Mullner and colleagues compared categories of amputation care for both groups that are typically associated with greater cost of care, such as length of stay, direct costs, readmissions and opiate therapy. According to the abstract, the average length of stay was 11.51 days for the amputation only group vs. 9.63 days in the group with nerve interventions.
“For the total average direct costs, it was statistically significant in every single group between them,” Mullner said.
“Similar with the mean ICU days, as well. It was lower in all of the groups that had amputation with nerve intervention and statistically significant in the majority, and then similar with opiate therapy, as well,” she said.
A future direction for related research would be a multicenter prospective study because it may elucidate other types of efficacy of nerve interventions, such as targeted muscle reinnervation, nerve transfers and regenerative peripheral nerve interfaces, for patients who undergo upper extremity amputation, Mullner said.
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James A, et al. Paper 5. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 29-Oct. 1, 2022; Boston.
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