Impact Of Socioeconomic and Injury Characteristics on Completion Of Outpatient Peripheral Nerve Care

PURPOSE: Accessibility of outpatient care is vital in managing peripheral nerve injuries (PNIs), as critical assessments such as imaging, electrodiagnostic studies, and potential surgical interventions must occur within specific time windows following the initial injury. This study investigates the predictors of outpatient follow-up completion status among PNI patients at a Level-I trauma center. METHODS: A 5-year retrospective review (2015-2020) was performed of adults (>18 years) treated for a PNI of the extremities at a single-institution. Chart review included demographics, primary insurance, distance from hospital, mechanism of injury, and Injury Severity Score (ISS). The time interval from index discharge to first outpatient clinic follow-up was recorded. Chi-squared and Kruskal-Wallis tests were used to identify predictors of follow-up completion status, and multivariate regression was used to assess independent associations. RESULTS: Among the 310 patients with PNIs identified, 198 (64%) sustained operative PNIs and 112 (36%) were managed non-operatively. Patients with operative PNIs had a shorter interval from index discharge to first outpatient follow-up compared with non-operative patients (22 vs 39 days, p=0.089). Higher ISS (range 1-43) was significantly associated with longer time to first clinic follow-up (p=0.022). Insurance coverage was distributed as follows: Medicaid (41%), private (29%), L&I (10%), Medicare (10%), and other (10%). Among payer types, L&I patients had the highest proportion of follow-up completion (85%), followed by private (58%), Medicare (47%), Medicaid (33%), and other (29%). Loss to follow-up was highest among patients with other insurance (61%), followed by Medicaid (56%), Medicare (53%), private (40%), and L&I (15%). In bivariate analysis, payer type, race, injury mechanism, open versus closed injury, assault at time of injury, and number of recommended treatments and diagnostics (PT/OT, EMG, splinting, imaging, prosthesis, and surgery) at first outpatient follow-up visit yielded statistically significant associations with follow-up completion status (p<0.006 for all, except injury mechanism, p=0.032, and open injury, p=0.017). In multivariate regression, payer types, race, material community deprivation index (MCDI), and number of recommendations at follow-up were statistically significant as predictors of becoming lost to follow-up. L&I was least likely to be lost, whereas Medicaid was most likely to be lost. CONCLUSION: These findings highlight the impact of both injury severity and socioeconomic factors on outpatient follow-up care for PNI. Although ISS is not specific to nerve injuries, higher ISS scores were associated with a delayed first outpatient follow-up, which may reflect mobility limitations and recovery needs in the setting of polytrauma patients. Socioeconomic disparities also play a notable role, as observed trends among MCDI and payer types suggest that underinsured patients face greater barriers to follow-up completion. Targeted strategies to improve access and continuity of care in these high-risk groups are warranted.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/OS25.cgi*