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Surgical Timing And Functional Outcomes In Brachial Plexus Birth Injury Repair: The Influence Of Clinical And Socioeconomic Factors
Thalia Le, BS, Kaitlin Olson, MS, Diego Gomez, BS, Phuong D. Nguyen, MD, Timothy Irwin, MD.
Children's Hospital Colorado, Denver, CO, USA.
PURPOSE: Brachial plexus birth injury (BPBI) outcomes depend on intervention timing and severity. Socioeconomic disparities may delay care and worsen recovery. This study examined socioeconomic and clinical factors influencing surgical timing and functional outcomes after primary BPBI repair
METHODS: A retrospective review of BPBI surgeries 2010 to 2024 at a tertiary pediatric center analyzed demographics, social vulnerability index (SVI) quartiles, and Narakas classification. Outcomes included surgical timing (≤12 vs >12 months), Mallet and AMS scores of ranges of motion. Logistic regression identified predictors of delayed surgery and function.
RESULTS: Among 106 surgically managed BPBI patients, 47 underwent nerve surgery, with 41 (87.2%) at ≤12 months and 6 (12.8%) after 12 months. SVI was not independently associated with surgical timing at nerve surgery (Q1 6.0 vs. Q4 9.0 months,
p=0.229), Narakas severity (
p=0.787), or functional outcomes by Mallet scores and AMS subscales. Patients with more severe injuries had earlier surgery (median 28.0 months for Narakas I vs 7.0 for IV,
p < 0.001). Early nerve surgery (≤12 months) was associated with higher median Mallet scores (14.0 vs. 7.5,
p=0.043) and superior AMS shoulder abduction (5.0 vs. 2.0,
p=0.035) compared with late nerve reconstruction. On multivariable analysis, higher Narakas grades predicted worse shoulder motion and Mallet performance (Narakas II:
β = −3.21, III:
β = −7.67, IV:
β = −6.90,
p<0.001).
CONCLUSION: Socioeconomic factors did not delay surgery or impair outcomes. Early nerve reconstruction improved function, while injury severity remained the strongest predictor of timing and recovery.
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