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Neuropathy Found Rare After Gynecologic Surgery


 

NEW ORLEANS — The incidence of neuropathy after gynecologic surgery appears to be fairly low, based on a prospective cohort study of more than 600 patients.

Dr. Justin C. Bohrer, an ob.gyn. at the Cleveland Clinic Lerner College of Medicine, presented data on his study at the annual meeting of the Society of Gynecologic Surgeons.

The authors enrolled 642 patients who underwent gynecologic surgery. The most common procedures were midurethral slings (26%, 166 patients); followed by vaginal prolapse surgery (25%, 160); abdominal hysterectomy (21%, 134); and hysteroscopy (16%, 102). Twenty-one percent of the procedures were conducted laparoscopically.

Of the total 642 enrolled, 611 subjects had a preoperative physical exam and neurologic history, asking about preexisting injuries and pain. Patients also were given a post-op neurologic exam within 24 hours of the procedure. Overall, 616 received that examination. Of the 616 patients, 12 (1.9%) were found to have a preexisting lower-extremity neuropathy. There were 14 new-onset peripheral nerve injuries in 11 patients, for an incidence of 1.8%, said Dr. Bohrer. Four of the neuropathies occurred in patients in boot stirrups and seven in those who were in candy cane stirrups.

The injuries were observed in the following nerves: lateral femoral cutaneous (five injuries), femoral (five), common fibular (one), ilioinguinal/iliohypogastric (one), saphenous (one), and genitofemoral (one). Bilateral femoral neuropathy was seen in three patients. Bilateral lateral femoral cutaneous neuropathy was seen in one patient. The injuries were mostly sensory, except for one of the bilateral femoral nerve injuries, which had motor and sensory components, said Dr. Bohrer, who reported no disclosures. No sacral nerve injuries were observed.

Looking at all the baseline characteristics, which included age, body mass index, race, tobacco use, and comorbidities such as diabetes, Dr. Bohrer found no significant differences between the groups.

The study had aimed to determine risk factors for neuropathy, but it was underpowered. It also did not fully account for patients who had a neuropathy more than 24 hours after surgery, he said. And because no nerve conduction studies were performed, the results were limited to only clinically significant injuries. Dr. Bohrer concluded that neuropathies are relatively rare in patients undergoing gynecologic surgery (at 1.9%), and that there is also a low incidence of injuries (1.8%).

Dr. Marc Toglia, a urogynecologist practicing in Philadelphia, commented that the study “does add significantly to our understanding of the topic.” He added that it is also “extremely timely” as Medicare is instituting new payment policies that hold hospitals and surgeons accountable for hospital-acquired injuries.

Dr. Bohrer's study 'does add significantly to our understanding of the topic.' DR. TOGLIA

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