Assessment of 30-Day Adverse Events in Single-Event, Multilevel Upper Extremity Surgery in Adult Patients with Upper Motor Neuron Syndrome

HAND, 2022 · DOI: 10.1177/1558944720975151 · Published: November 25, 2020

Simple Explanation

Upper motor neuron (UMN) syndrome consists of muscle spasticity, weakness, and dyssynergy due to a brain or spinal cord injury. The purpose of this study is to describe the perioperative adverse events for adult patients undergoing single-event, multilevel upper extremity surgery (SEMLS) due to UMN syndrome. A retrospective case series was performed for 12 consecutive adult patients who underwent SEMLS to correct upper extremity dysfunction or deformity secondary to UMN syndrome. The evaluation consisted of primary outcome measures to identify readmission rates and classify adverse events that occurred within 30 days after surgery. All 12 patients were functionally dependent with 50% (n = 6) men and 50% (n = 6) women at a mean age of 43.6 years (range: 21-73) with a mean of 5.92 (range: 0-16) comorbid diagnoses at the time of surgery.

Study Duration

August 2017 until October 2019

Participants

12 adult patients with Upper Motor Neuron Syndrome

Evidence Level

Level IV

Key Findings

1
There were no intraoperative complications, hospital readmissions, or deaths among the 12 patients.
2
Five patients experienced 5 minor postoperative complications that consisted of cast- or orthosis-related skin breakdown remote from the incision (n = 3), incidental surgical site hematoma that required no surveillance or intervention (n = 1), and contact dermatitis attributed to the surgical dressing that resolved with topical corticosteroids (n = 1).
3
With an appropriate multidisciplinary approach, there is minimal risk for developing perioperative and 30-day postoperative adverse events for adults undergoing SEMLS to correct upper extremity deformities secondary to UMN syndrome.

Research Summary

Upper motor neuron (UMN) syndrome consists of muscle spasticity, weakness, and dyssynergy due to a brain or spinal cord injury. The purpose of this study is to describe the perioperative adverse events for adult patients undergoing single-event, multilevel upper extremity surgery (SEMLS) due to UMN syndrome. A retrospective case series was performed for 12 consecutive adult patients who underwent SEMLS to correct upper extremity dysfunction or deformity secondary to UMN syndrome. The evaluation consisted of primary outcome measures to identify readmission rates and classify adverse events that occurred within 30 days after surgery. With an appropriate multidisciplinary approach, there is minimal risk for developing perioperative and 30-day postoperative adverse events for adults undergoing SEMLS to correct upper extremity deformities secondary to UMN syndrome.

Practical Implications

Safety of SEMLS

SEMLS for upper extremity reconstruction in adult patients with UMN syndrome is safe, reducing surgical encounters and allowing uninterrupted rehabilitation.

Multidisciplinary Approach

Close monitoring by a multidisciplinary team can reduce adverse events in patients with poor functional status and increased ASA class.

Adverse Event Reduction

Proper deep drain placement and frequent integument monitoring can prevent hematoma formation and skin breakdown.

Study Limitations

1
Small sample size limits statistical analysis and comparison to control groups.
2
30-day postoperative study period may not capture all adverse events.
3
Study lacks subjective and objective outcomes of patients undergoing SEMLS.

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