TOPLINE:

Although the incidence of perioperative nerve injuries (PPNIs) appears to be declining, patients who receive a combination of regional and general anesthesia are at increased risk for the problem, a study from Australia finds. Increased comorbidity and obesity are independent risk factors, the researchers noted.

METHODOLOGY:

• Researchers analyzed 5,451,848 nonmaternity surgical admissions from a dataset (2015-2024) including patient admissions to public and private hospitals in Victoria, Australia, to identify the incidence of PPNIs and associated risk factors.
• The surgical admissions were associated with general, regional, or combined anesthesia or sedation.
• Nerve injuries were categorized as “all nerve injuries” or “specified nerve injuries” based on the complications recorded.
• Clinical variables included the American Society of Anesthesiologists physical status, obesity, and the Charlson comorbidity index.

TAKEAWAY:

• The incidence of all PPNIs was 14.6 per 100,000 surgical admissions, with 796 injuries recorded. The most common injury sites were the wrist and hand, neck, and hip and thigh, with the rate of specific nerve injuries at 7.5 per 100,000 admissions.
• Combined regional and general anesthesia vs general anesthesia alone was associated with an increased risk for all nerve injuries (odds ratio [OR], 2.07; 95% CI, 1.72-2.49) and specified nerve injuries (OR, 2.68; 95% CI, 2.11-3.39).
• Obesity (OR, 2.04; 95% CI, 1.54-2.69) and a Charlson comorbidity index score of 2 (OR, 2.61; 95% CI, 1.87-3.65) were significant risk factors for specified nerve injuries.
• The rates of nerve injury were higher among male patients than among female patients (17.0 vs 12.6 per 100,000 surgical admissions). From 2015 to 2024, the rates of PPNIs decreased from 21.0 to 11.3 per 100,000 admissions and those of specific injuries decreased from 9.6 to 6.5 per 100,000 admissions.
• Patients aged 15-24 years were more likely to sustain a nerve injury than those aged 25-35 years; the OR for injury declined by roughly 0.1 per decade after age 35 years.

IN PRACTICE:

“These injuries appear to occur less frequently than estimated previously, and reduced rates over time suggest PPNIs are being underreported, or improvements are being made in contemporary practices. A combination of regional anesthesia and general anesthesia or sedation, increasing patient comorbidity, obesity and specific procedure types are associated with” the complication, according to the researchers.

SOURCE:

The study was led by Tom Luo of the Department of Anaesthesia at the Peninsula Health in Melbourne, Australia. It was published online on December 1, 2025, in Anaesthesia.

LIMITATIONS:

Injuries were identified over a short average hospital stay of 5.5 days. Transient injuries may be underreported. Detailed information on specific anesthesia techniques and patient positioning was lacking.

DISCLOSURES:

The authors declared having no external funding or competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.