Incidence of peri-operative peripheral nerve injuries associated with general and regional anaesthesia: an observational study

Introduction: Peri-operative peripheral nerve injuries are rare, and estimating their incidence and identifying risk factors is difficult. Previous data attempting to determine the incidence come from single-centre studies or small database reviews, making it difficult to draw definitive conclusions. Methods: We used the Victorian Admitted Episodes Dataset, an established state-wide dataset of public and private hospital admissions, to determine the incidence and risk factors for developing peri-operative peripheral nerve injuries in the state of Victoria, Australia, from 2015 to 2024. Results: A total of 5,451,848 non-maternity surgical admissions were analysed, with 796 nerve injuries as a complication of care. This represents a rate of 14.6 nerve injuries per 100,000 (0.014%) surgical admissions, with a subset of 407 specific nerve injuries of interest (the most common nerve injuries previously identified by American Society of Anesthesiologists closed claims analyses) at a rate of 7.5 per 100,000 (0.007%) surgical admissions. The risk of specific peri-operative nerve injuries increased significantly in patients receiving combined regional anaesthesia with general anaesthesia or sedation (odds ratio 2.68, 95%CI 2.11–3.39); patients living with obesity (odds ratio 2.04, 95%CI 1.54–2.69) and those with increased Charlson comorbidity index (odds ratio 2.61, 95%CI 1.87–3.65 for Charlson comorbidity index of 2). Procedures on the cardiovascular system (odds ratio 3.75, 95%CI 2.85–4.92), musculoskeletal system (odds ratio 3.30, 95%CI 2.59–4.20) and nervous system (odds ratio 3.17, 95%CI 2.43–4.14) had the highest risk of specified injuries. Discussion: The risk of peri-operative peripheral nerve injuries is lower than historical estimates and appears to be decreasing with time. The use of administrative databases allows for inclusion of denominator data to allow for a more accurate estimate of risk in rare events, such as peri-operative peripheral nerve injuries.