A Review of Outcomes of End-to-Side Neurorrhaphy: Does Age Matter?
Matthew R. Zeiderman MD 1; Dattesh R. Dave MD, MSc 1; Derek B. Asserson MD 2; Chetan S. Irwin MD 1; Clifford T. Pereira MD, FACS, FRCS 1 1 Department of Surgery, Division of Plastic & Reconstructive Surgery, UC Davis Medical Center 2 California Northstate University College of Medicine
Background: Outcomes of end-to-side (ETS) neurorrhaphy for treatment of peripheral nerve injury remain controversial given the breadth of applications, injury mechanism, and injury location. Appropriate indications for ETS neurorrhaphy remain debated. We hypothesize differences in age, sex, and time-to-surgery all influence outcomes.
Methods: We performed a search of the PubMed database for ETS neurorrhaphy coaptation in the upper extremity from 1988-2018. Age, sex, transfer location, time-to-surgery, and change in strength and/or sensation as measured by Medical Research Council (MRC) scale was extracted from articles. Meaningful recovery was classified as MRC Grade 3 or greater motor or sensory function. Independent sample t-test was performed to analyze changes in motor and sensory function for adults vs. children, adult males vs. females, and amongst adult age groups. Linear regression analysis using Pearson correlation coefficient was used to correlate time-to-surgery and age with motor and sensory outcome. Logistic regression was performed to correlate time-to-surgery with meaningful recovery.
Results: 96 adult and 10 pediatric patients were included. Independent sample t-test yielded no statistically significant relationship between change in sensation (p=0.366) or strength (p=0.933) for adults vs. children. No statistically significant relationship between change in sensation (p=0.572) or strength (p=0.891) was found for adult males vs. adult females. Independent samples t-test approached statistical significance for motor improvement in adults aged 18-25 vs. 26+ (p=0.056). On Linear regression analysis, age weakly correlated with sensory (Γ=0.134, p=0.370) and motor improvement (Γ= -0.140, p=0.287). Time-to-surgery weakly correlated with sensory (r= -0.194, p=0.257) and motor improvement (Γ= -0.254, p=0.078). On logistic regression analysis, time-to-surgery negatively correlated with meaningful recovery with a Spearman rank coefficient Γ= -0.167 (p=0.214).
Conclusion: Adults aged 18-25 may have better motor outcomes from ETS neurorrhaphy than older adults, as graded by the MRC scale. Negative correlation between time-to-surgery and motor outcomes approached statistical significance. No statistically significant functional improvement from ETS nerve coaptation were identified between pediatric and adult patients, females vs. males, or young vs. old adult age groups. Given the variety of injury mechanisms, surgical techniques and time to presentation, the efficacy of ETS neurorrhaphy is difficult to evaluate. However, age or gender do not seem to affect outcomes.
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