Upper limb reconstructive surgery uptake for persons with tetraplegia in New Zealand: a retrospective case review 2001–2005

Abstract

Study design: Retrospective case series. Objective: To describe the uptake of upper limb surgery by individuals with tetraplegia in New Zealand (NZ). Setting: New Zealand. Methods:The clinical notes of all individuals who sustained a cervical spinal cord injury between 1 January 2001 and 31 December 2005 were retrospectively reviewed for those who met the clinical criteria to undergo upper limb surgery. Cases were cross-referenced to the hand surgery record to determine the uptake of upper limb surgery in this cohort. Results: The uptake of upper limb surgery for people with tetraplegia in NZ was 44% of the eligible cohort and 59% of those assessed for surgery. This is notably higher than the reported proportion in other developed countries. The data also suggested that women and those who identified as NZ Maori were less likely to undergo upper limb surgery than were men and those of NZ European ethnicity. Conclusion: Utilization of upper limb surgery in the eligible tetraplegic population in NZ was high. However, it seemed that some groups were less likely to undergo surgery. Further research into the factors that affect an individual's decision to undergo upper limb surgery could explain the observed pattern.

A Mixed Methods Approach as a Channel to Interpret Outcomes Research and Lived Experience Enquiry of Upper Extremity Elective Surgery for Tetraplegia

“…Individuals with tetraplegia need to be referred to these services to be fully informed about their options, and the service needs to be accessible/flexible to meet their needs. Significant differences in access and equity to such services are apparent within the literature for UE surgery for tetraplegia, where in the United States, only 7% of eligible people with tetraplegia have UE reconstructive procedures [ 42 , 43 , 44 ] compared to Aotearoa/New Zealand, with the uptake closer to half the eligible population [ 45 ]. However, urgent investigation is required given previously reported differences for surgery uptake for Māori in this cohort [ 23 ].…”

Issues influencing the decision to have upper limb surgery for people with tetraplegia

“…5 A previous NZ study found that the uptake of reconstructive UL surgery was close to half (44%) the eligible population. 6 Uptake in the New Zealand is substantively higher than the reported uptake in the United States, [7][8][9] although in the New Zealand, women and those who identified as NZ Maori were underrepresented in the surgery group. 6 Low uptake of reconstructive UL surgery is an important issue worldwide.…”

“…6 Uptake in the New Zealand is substantively higher than the reported uptake in the United States, [7][8][9] although in the New Zealand, women and those who identified as NZ Maori were underrepresented in the surgery group. 6 Low uptake of reconstructive UL surgery is an important issue worldwide. One of the most commonly cited reasons for low utilisation in the United States is the lack of clarity in the existing literature about the value of the procedures performed 5,[8][9][10][11] This makes it difficult for physicians and health professionals to summarise useful information from the literature for patients and even more difficult for people with tetraplegia to find this information for themselves.…”

“…From the population identified in an earlier study, 6 after ethical and locality approvals were obtained, 22 participants were recruited from the two spinal units in the New Zealand. The first eight participants were selected to embody a range of demographic characteristics, and thereafter theoretical sampling was used to choose participants who had demographic or other characteristics not already represented.…”