Factors Associated with 30-Day Adverse Events After Brachial Plexus Neurolysis

This study aimed to identify factors associated with complication, hospital readmission, and reoperation in a 30-day postoperative period after brachial plexus neurolysis.

A retrospective case-control study was performed using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology code for brachial plexus neurolysis from 2011 to 2020. A cohort of 691 adult patients who underwent brachial plexus neurolysis was included. The outcome variables were 30-day postoperative complication, readmission, and reoperation. A bivariate screen was performed for explanatory variables associated with our outcome variables, and variables with a P value of <.05 in the bivariate screening were included in a multivariable logistic regression model.

Of the 691 patients in our cohort, 20 (2.9%) developed a postoperative complication, 31 (4.5%) were readmitted, and 22 (3.2%) underwent reoperation during the 30-day postoperative period. Bivariate analysis showed that longer operative times were associated with complication, and concurrent rib resection was associated with readmission; no other variables met the inclusion criteria in a multivariable logistic regression model for complication and readmission. Multivariable logistic regression analysis showed that a lower body mass index and longer operative time were independently associated with reoperation.

Episode-of-care postoperative complication and reoperation after brachial plexus neurolysis are associated with operative time, which may be partially related to surgical complexity, additional procedures, and/or surgeon experience. Rib resection procedures are associated with a higher risk of readmission.

Our findings may be applied to preoperative risk stratification and patient counseling. Our research questions the role of bony rib resection in the routine treatment of neurogenic thoracic outlet syndrome when soft tissue release alone may be successful. Future research is necessary to define risk profiles for different surgical indications and concomitant procedures.

Prognostic III.