gms | German Medical Science

Objectives/Interrogation: Nerve injuries are considered to be highly cost intensive due to the specialized therapy, rehabilitation and long healing processes. So far only few European cost analyses are available from small Swedish and Swiss collectives (<100 patients) and none for the German collective. Therefore, even the international treatment guidelines have no strong data to refer to. This study evaluates for the first time the epidemiology and costs of peripheral nerve lesions within the German health system of more than 1000 patients.

Methods: All patients who were treated with a peripheral nerve lesion of the upper extremity between 01/2012 and 12/2017 were retrospectively analyzed for epidemiological and economical aspects. For cost analysis patients were divided into work-related and private causes due to the different insurance covering. Within this period, the costs of inpatient treatment (diagnostics, operation, ward days) and rehabilitation were calculated.

Results and Conclusions: A total of 1015 patients were identified, of which 556 (55%) were work related and 431 private injuries. Mean age of patients was 39.9 yrs, 85.2% were male, mean hospital stay was 7.03 days. 47% of patients had a median nerve injury, 32.11% an ulnar nerve injury and 20.5% a radial nerve injury. 17% of cases had a combined injury of two nerves. 66.8% were sensory finger nerve injuries, 78% were complete transections, 11.6% partial and 10.4% were lesions in continuity. In 40.8% 1-3 tendons were additionally injured, in 45.2% 1 artery was additionally injured. 82.8% of cases were operated within 24 hrs, main treatment was primary coaptation. 16% required inpatient rehabilitation, mean absence from work were 166.79 days. Mean costs of sensory nerve lesions (finger level) were 2.673,15E and increased in combined motor and sensory nerve injuries (arm level) up to 10.822,14E. Median nerve injury resulted in mean costs of 4.526,56E, radial nerve injury in mean costs of 6.861,47E and single ulnar nerve injury revealed 6.253,67E. Combined injury with tendon or artery lesions increased the costs significantly. Mean inpatient rehabilitation costs were 5.842,35E.

Injury to the peripheral nerves has a major impact on the function of the arm and hand, the patient's life and employment. With the analysis of more than 1000 cases we answered the need to obtain objective and reliable data on the epidemiological and economical structure of these injuries.