Iatrogenic Upper Limb Nerve Injuries

Abstract

Background: Complications due to errors made by health practitioners are a major cause of concern and a source of distress, disability, and death in patients. In addition, they are associated with litigation and impose a major financial burden on healthcare budgets. Peripheral nerve injuries are among the most frequent iatrogenic complications. Recently, numerous studies have explored specific iatrogenic nerve injuries and possible ways of improving patient safety and preventing error. However, there are few data on the spectrum and relative frequency of iatrogenic nerve injuries and no national studies have been undertaken.

Aim: To describe the current spectrum of iatrogenic upper limb nerve injuries in New Zealand, focusing particularly on injuries that have an anatomical and possibly preventable component.

Methods: Three studies were undertaken. (1) A systematic review of English biomedical literature in the last ten years relating to major iatrogenic upper limb nerve injuries. The context, mechanism and frequency of nerve injuries were recorded. (2) A retrospective analysis of the Accident Compensation Corporation‟s (ACC) accepted claims database from the first six months of 2009, focusing on iatrogenic nerve injuries. (3) An educational poster targeted at operating staff using international recommendations was produced in consultation with local practising anaesthesiologists.

Results: The systematic literature review revealed iatrogenic upper limb nerve injuries are relatively common and can affect patients in any surgical specialty. The spectrum of injuries has changed in parallel with technological advances in surgery and medicine. Analysis of the ACC‟s database revealed 151 successful treatment injury claims that could be classified as iatrogenic nerve injury during the study period. The majority of claimants were female (54.9%) and the elderly was over-represented with the median age being 51.5yrs, (range 0-83yrs). The five most frequent iatrogenic injuries were to the median nerve, sciatic nerve, common fibular nerve, radial nerve and ulnar nerve. An educational poster demonstrating the dos and don‟ts of upper limb positioning under general anaesthesia was successfully produced.

Conclusion: This study has described for the first time the contemporary spectrum of iatrogenic nerve injuries in New Zealand as reported to the ACC. Appreciation and raising awareness of the risks associated with medical procedures is an essential first step in developing and implementing strategies to reduce iatrogenic injuries and improve patient safety. This study provides invaluable data by highlighting the procedures that need most attention. Future application of these results will hopefully benefit everyone involved in the New Zealand healthcare system.