Search

Background: Understanding patterns of peripheral nerve injuries (PNIs) and brachial plexus injuries (BPIs) is essential to preventing and appropriately managing nerve injuries. We sought to assess the incidence, cause, and severity of PNIs and BPIs sustained by patients with trauma. Methods: We conducted a retrospective review of the Trauma Registry Database (January 2002 to December 2020) to identify patients with PNIs or BPIs. Results: We evaluated data from 24 905 patients with trauma; 335 (1.3%) sustained PNIs (81% male; mean age 36 yr, standard deviation [SD] 16 yr) and 64 (0.3%) sustained BPIs (84% male; mean age 35, SD 15 yr). Nerves in the upper extremities were more commonly affected than those in the lower extremities. Sharp injuries (39.4%) and motorcycle accidents (32.8%) were the most frequent causes of PNIs and BPIs, respectively. Other common causes of PNI were motor vehicle collisions (16.7%) and gunshot wounds (12.8%). Many patients with PNIs (69.0%) and BPIs (53%) underwent operative management. The most frequent reconstruction for PNI was primary nerve repair (66%), while nerve transfers (48%) were more frequently used for BPI. Conclusion: Nerve injuries in the trauma population have decreased over the last 3 decades with shifts in mechanisms of injury and use of imaging, electrodiagnostic tests, and surgery. Nerve injuries are often complex and time-sensitive to treat; understanding changes in trends is important to ensure optimal patient management. Contexte : Il est essentiel de comprendre le m canisme de survenue des l sions des nerfs p riph riques (LNP) et du plexus brachial (LPB) pour les pr venir et les traiter ad quatement. Nous avons voulu valuer l'incidence, la cause et la gravit des LNP et des LPB, chez des patient(e)s polytraumatis (e)s. M thodes : Nous avons proc d une revue r trospective de la base de donn es du Registre de traumatologie (janvier 2002 d cembre 2020) pour recenser les cas de LNP et de LPB. R sultats : Nous avons examin les donn es de 24 905 patient(e)s polytraumatis (e)s; 335 (1,3%) avaient subi des LNP (81% de sexe masculin; ge moyen 36 ans, carttype [ .-T.] 16 ans) et 64 (0,3%), des LPB (84% de sexe masculin; ge moyen 35 ans, .-T. 15 ans). Les nerfs des membres sup rieurs taient atteints plus souvent que les nerfs des membres inf rieurs. Les blessures caus es par un objet tranchant (39,4%) et les accidents de motocyclette (32,8%) ont t le plus souvent l'origine des LNP et des LPB, respectivement. Les autres causes fr quentes de LNP taient les accidents de la route (16,7%) et les blessures par balle (12,8%). De nombreux cas de LNP (69,0%) et de LPB (53%) ont t trait s chirurgicalement. La reconstruction la plus utilis e pour les LNP a t la r paration primaire (66%), tandis que le transfert nerveux (48%) a davantage t utilis pour les LPB. Conclusion : Le nombre de l sions nerveuses observ es en traumatologie a diminu depuis une trentaine d'ann es et leurs m canismes de survenue, le recours l'imagerie, les tests lectrodiagnostiques, et les techniques chirurgicales ont volu . Les l sions nerveuses sont souvent complexes et leur traitement est urgent; il est important de comprendre l' volution des tendances pour assurer leur prise en charge optimale., Peripheral nerve injury (PNI) may result in activity loss, pain, depression, disability, and reduced quality of life. (1-3) Most brachial plexus injuries (BPIs) affect young people and create a financial [...]

Background: To better understand the occurrence and operative treatment of peripheral nerve injury (PNI) and the potential need for additional resources, it is essential to define the frequency and distribution of peripheral nerve procedures being performed. The objective of this study was to evaluate Ontario's wait times for delayed surgical treatment of traumatic PNI. Methods: We retrieved data on wait times for peripheral nerve surgery from the Ontario Ministry of Health and Long-Term Care Wait Time Information System. We reviewed the wait times for delayed surgical treatment of traumatic PNI among adult patients (age > 18 yr) from April 2009 to March 2018. Data collected included total cases, mean and median wait times, and demographic characteristics. Results: Over the study period, 7313 delayed traumatic PNI operations were reported, with variability in the case volume distribution across Local Health Integration Networks (LHINs). The highest volume of procedures (2788) was performed in the Toronto Central LHIN, and the lowest volume (< 6) in the Waterloo Wellington and North Simcoe Muskoka LHINs. The population incidence of traumatic PNI requiring surgery was 5.1/10 000. The mean and median wait times from surgical decision to surgical repair were 45 and 27 days, respectively. Both the longest and shortest wait times occurred in LHINs with low case volumes. The provincial target wait time was met in 93% of cases, but women waited significantly longer than men (p < 0.001). Conclusion: The provincial distribution of traumatic PNI surgery was variable, and the highest volumes were in the LHINs with large populations. The provincial wait time strategy for traumatic PNI surgery is effective, but women waited longer than men. Precise reporting from all hospitals is necessary to accurately capture and understand the delivery of care after traumatic PNI. Contexte : Pour mieux comprendre l'incidence et le traitement chirurgical des lésions nerveuses périphériques (LNP) traumatiques et la nécessité potentielle d'ajouter des ressources, il est essentiel d'établir la fréquence et la distribution des interventions effectuées pour les LNP. L'objectif de cette étude était de mesurer les temps d'attente pour le traitement chirurgical retardé des LNP traumatiques. Méthodes : Nous avons consulté les données sur les temps d'attente pour les chirurgies des LNP du ministère de la Santé et des Soins de longue durée de l'Ontario. Nous avons relevé les temps d'attente pour le traitement chirurgical retardé des LNP traumatiques chez les patients adultes (âge [greater than or equal to] 18 ans) entre avril 2009 et mars 2018. Les données recueillies incluaient les nombres totaux de cas, les temps d'attente moyens et médians et les caractéristiques démographiques. Résultats : Pendant la période de l'étude, on a recensé 7313 interventions retardées pour des LNP traumatiques, et la distribution des volumes de cas variait d'un Réseau local d'intégration des services de santé (RLISS) à l'autre. Le plus fort volume d'interventions (2788) a été enregistré dans le RLISS du Centre-Toronto, et le plus faible (< 6), dans les RLISS Waterloo Wellington et North Simcoe Muskoka. L'incidence des LNP traumatiques nécessitant une chirurgie était de 5,1/10 000 de population. Les temps d'attente moyens et médians entre la décision d'opérer et la correction chirurgicale ont été de 45 et 27 jours, respectivement. Le plus long et le plus court temps d'attente ont été enregistrés dans les RLISS où les volumes de cas étaient faibles. Le temps d'attente cible pour la province a été respecté dans 93% des cas, mais les femmes ont attendu significativement plus longtemps que les hommes (p < 0,001). Conclusion : La distribution provinciale des chirurgies pour LNP a varié et les volumes les plus forts ont été enregistrés dans les RLISS les plus populeux. La stratégie provinciale sur les temps d'attente en ce qui concerne la chirurgie pour LNP traumatique est efficace, mais les femmes ont attendu plus longtemps que les hommes. Il est nécessaire que tous les hôpitaux préparent des rapports précis afin de comprendre et refléter fidèlement la prestation des soins pour les LNP traumatiques., Peripheral nerve injury (PNI) can result in profound motor and sensory impairments with high levels of disability. (1-4) When a PNT does not resolve spontaneously, timely surgical intervention is essential [...]

Decisional confict represents a state of uncertainty regarding an action one must take. It is a concept inherent to shared decision-making and can help promote high-quality and patient-centred decisions in surgical care, leading to better outcomes. Specific elements may cause more uncertainty or decisional confict for patients: lack of knowledge about risks and benefits, poorly defined personal values about the importance of those risks and benefits, perception of a lack of support, unpredictable outcomes, or the impression that an inadequate decision has been made. Decisional confict can be measured in the surgical setting using the 16-item validated patient-reported Decisional Confict Scale (DCS). Better understanding of the reasons behind high decisional confict can help surgeons support high-quality decisions and lead to more satisfactory outcomes and less decisional regret., Patients' experiences, preferences and outcomes assessments have been guiding surgeons' approach to clinical care toward patient-centred care, which is defined as care that involves shared decision-making with patients while promoting [...]

Introduction: People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function. Objective: To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function. Design: Prospective cohort study. Participants were followed up for 24 months and completed up to three interviews. Setting: Tertiary care at academic and affiliated Veterans Administration Health Care Centers. Participants: Adults with cervical SCI (n = 35) ages 18 to 80 years with mid‐cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least 6 months post‐injury) and their caregivers (n = 23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery. Interventions: Not applicable. Main Outcome Measure: Semi‐structured interviews about surgical knowledge and experiences. Results: Data were analyzed and three themes were identified. First, providing information about UE surgical options early post‐injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information. Conclusions: Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and health care providers. [ABSTRACT FROM AUTHOR]

Background: Despite increased public awareness to dispose of unused narcotics, opioids prescribed postoperatively are retained, which may lead to drug diversion and abuse. This study assessed retention of unused opioids among hand surgery patients and describes disposal methods and barriers. Methods: Participants undergoing hand surgery were given an opioid disposal information sheet preoperatively (N = 222) and surveyed postoperatively to assess disposal or retention of unused opioids, disposal methods, and barriers to disposal. A binomial logistic regression was conducted to assess whether age, sex, pain intensity, and/or the type of procedure were predictors of opioid disposal. Results: There were 171 patients included in the analysis (n = 51 excluded; finished prescription or continued opioid use for pain control). Unused opioids were retained by 134 patients (78%) and disposal was reported by 37 patients (22%). Common disposal methods included returning opioids to a pharmacy (49%) or mixing them with an unwanted substance (24%). Reasons for retention included potential future use (54%), inconvenient disposal methods (21%), or keeping an unfilled prescription (9%). None of the patient factors analyzed (age, sex, type of procedure performed, or pain score) were predictors of disposal of unused narcotics (P >.05). Conclusions: Most patients undergoing hand surgery retained prescribed opioids for future use or due to impractical disposal methods. The most common disposal methods included returning narcotics to a pharmacy or mixing opioids with unwanted substances. Identifying predictors of disposal may provide important information when developing strategies to increase opioid disposal. [ABSTRACT FROM AUTHOR]

Adequate health literacy is essential to navigate the healthcare system and has a major role in peri-operative care and outcomes. Minimal information exists regarding surgeons' understanding of health literacy, clinical implications, and awareness of universal measures of support. This study assessed Canadian surgeons' perceptions of patients' health literacy and their knowledge of available supportive resources. We conducted a cross-sectional study using an electronic survey distributed to surgeons at academic institutions. Data collected included sociodemographics, health literacy knowledge, and practice surrounding the use of supportive measures. Across four Canadian academic institutions (University of Toronto, McMaster University, University of Alberta, and University of Calgary), 35 surgeons from various surgical specialties, including general, plastic, and orthopedic surgery, completed the survey. Approximately 74% of surgeons reported familiarity with the concept "health literacy", but they used general impressions to estimate their patients' health literacy levels. Surgeons' perceptions were that patients who had proficient health literacy represented 50% or less of their practice. However, knowledge of supportive tools for measuring patient health literacy was variable. Surgeons familiar with health literacy spent significantly more time (>15 minutes) counselling patients (38%, p=0.02) and used language at a 10th grade level or less (92%, p=0.04). Common supportive measures included using simple, non-medical terms (97%, n=34), repetition (83%, n=29), and drawing pictures/diagrams (83%, n=29). This study highlights the importance of surgeon awareness of health literacy and how improved awareness may guide patient-surgeon interactions and improve the quality of care. [ABSTRACT FROM AUTHOR]