Predictive factors for postoperative complications in nerve grafting neurorrhaphies: A multispecialty analysis using NSQIP data

Background: To date, no large-scale research has comprehensively examined predictors of complications following neurorrhaphy with nerve grafts. This study aims to clarify the factors that can predict postoperative complications within 30 days of nerve graft surgeries. Methodology: Data was collected from the American College of Surgeons National Quality Improvement Program (ACS NSQIP) using Current Procedural Terminology (CPT) Codes. A receiver operating characteristic (ROC) curve was created for operative time analysis. Relevant 30-day morbidities and mortality variables were run using univariate and multivariate statistical analyses. All statistical analyses were conducted using SPSS version 29. Results: The mean age of patients undergoing neurorrhaphy was 46.5 ± 16.7 years, with males comprising the majority (56.9 %). The overall 30-day complication rate was 11.1 %, with the most common complications being bleeding requiring transfusion (4.27 %) and superficial surgical site infections (2.8 %). The mean operative time was 4.6 ± 3.4 h, and the mean length of hospital stay was 2.1 ± 5.9 days. Univariate analysis identified nine preoperative variables (female sex, dialysis, disseminated cancer, steroid use, abnormal WBC, anemia, transfusions, mFI-5 score, and ASA class) and one intraoperative variable (long operative time) as significantly associated with 30-day morbidity. The multivariate model confirmed five independent predictors of 30-day morbidity: abnormal WBC (OR 2.061, p < 0.001), anemia (OR 2.233, p < 0.001), mFI-5 score ≥ 1 (OR 1.411–1.725, p = 0.011–0.023), ASA class ≥ 3 (OR 1.424, p = 0.011), and long operative time (>5.29 h, OR 5.887, p < 0.001). For 30-day mortality, univariate analysis found four significant preoperative predictors: dialysis (OR 99.875, p < 0.001), anemia (OR 6.179, p = 0.046), mFI-5 score of 1 (OR 12.571, p = 0.024), and ASA class ≥ 3 (OR 9.35, p = 0.046). Multivariate analysis suggested dialysis as a critical predictor of 30-day mortality (OR 26.513, p = 0.043). These findings highlight key preoperative and intraoperative factors influencing short-term morbidity and mortality following neurorrhaphy. Conclusions: Complications after nerve surgery can be an additional burden on patients. Most complications occur within 30 days of surgery. Frailty, higher ASA class, leukocytosis, anemia, and operative time can predict 30-day morbidities. Dialysis is a potential predictor of 30-day mortality. Understanding the influence of preoperative factors on postoperative outcomes is necessary to mitigate risk and maximize recovery after surgery.