Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity

BackgroundPeripheral nerve injury in the upper extremity is linked to high socioeconomic burden, yet cost-analyses are rare and from small cohorts. The objective of this study was to determine the costs and long-term socioeconomic effects of peripheral nerve injuries in the upper extremity in Germany.MethodsWe analyzed data of 250 patients with 268 work-related upper extremity nerve injuries from acute treatment to long-term follow-up on rehabilitation, sick-leave and disability-pension.ResultsPatients were on average 39.9±14.2 years old, male (85%) and mean inpatient treatment was 7±6 days. Location of nerve was 8% (N = 19) proximal to the wrist, 26% (N = 65) at the wrist and metacarpus, and 66% (N = 166) at phalangeal level. Acute in-patient treatment for (single) median nerve injury accounted for 66% with hospital reimbursement of 3.570€, ulnar nerve injury for 24% and 2.650€ and radial nerve injury for 10% and 3.166€, all including finger nerve injuries. The remaining were combined nerve injuries, with significantly higher costs, especially if combined with tendon 5.086€ or vascular injury 4.886€. Based on location, nerve injuries proximal to the wrist averaged 5.360±6.429€, at the wrist and metacarpus 3.534±2.710€ and at the phalangeal level 3.418±3.330€. 16% required rehabilitation with average costs of 5.842€ and stay of 41±21 days. Sick leave was between 11–1109 days with an average of 147 days with socioeconomic costs of 197€/day, equaling on average 17.640€. 30% received a mean yearly disability pension of 3.187€, that would account to 102.167€ per lifetime.ConclusionThis large German patient sample indicates that nerve injury has a major impact on function and employment, resulting in significant health care costs. Both proximal and distal nerve injuries led to long-term disability, subsequent sick-leave and in 30% to permanent disability pension. These data are determined to support future studies and health economical work on prevention, treatment and rehabilitation of these often small injuries with great consequences.背景 上肢周围神经损伤（peripheral nerve injury）往往伴随高昂的社会经济负担，但相关成本分析较为稀缺且多基于小样本队列。本研究旨在明确德国上肢周围神经损伤的医疗成本与长期社会经济影响。 方法 本研究分析了250例患者共计268起职业性上肢周围神经损伤的数据，覆盖从急性期治疗到康复、病假及伤残津贴的长期随访全流程。 结果 受试者平均年龄为39.9±14.2岁，男性占比85%，平均住院时长为7±6天。神经损伤部位分布为：腕部近端8%（N=19）、腕部及掌骨26%（N=65）、指骨水平66%（N=166）。单纯正中神经（median nerve）损伤占比66%，医院报销金额为3570欧元；尺神经（ulnar nerve）损伤占比24%，报销金额为2650欧元；桡神经（radial nerve）损伤占比10%，报销金额为3166欧元，以上均包含指神经损伤病例。其余为合并神经损伤，其医疗成本显著更高，尤其是合并肌腱损伤（5086欧元）或血管损伤（4886欧元）的病例。按损伤部位划分，腕部近端神经损伤的平均成本为5360±6429欧元，腕部及掌骨损伤为3534±2710欧元，指骨水平损伤为3418±3330欧元。16%的患者需要接受康复治疗，平均康复成本为5842欧元，平均康复住院时长为41±21天。患者病假时长介于11~1109天，平均病假时长147天，每日社会经济成本为197欧元，总平均社会经济成本为17640欧元。30%的患者获得年均3187欧元的伤残津贴，按终身计算总计可达102167欧元。 结论 本项基于德国大样本患者队列的研究表明，周围神经损伤会对患者功能与就业造成严重影响，并产生高额医疗成本。腕部近端与远端神经损伤均可导致长期残疾、后续病假，且30%的患者最终获得永久性伤残津贴。本研究数据旨在为后续相关预防、治疗及康复的研究与卫生经济学工作提供支撑，这类看似轻微的损伤实则会造成严重后果。