Timing of surgery as outcome predictor in brachial plexus injury: a systematic review and meta-analysis

Objectives. To evaluate the evidence of timing of surgery in Brachial plexus injury and neurological outcome.

Data sources. The search included PubMed (until November 2022); Scopus (until March 2023); Central Cochrane Registry of Controlled Trials (The Cochrane Library) (until March 2023); MEDLINE (Ovid) until 2023; November EMBASE (Ovid); CINAHL (until March 2023). Study selection. All articles that reported assessment timing of surgery in Brachial Plexus Injury (BPI), poor neurological and functional outcome.

Data extraction. Study type, publication year, number of patients, level of lesion, preoperatory assessment, delayed of operation, operative management, follow up. We performed a meta-analysis for each variable which there was important data to estimate the importance of surgical time in the management of BPI.

Data synthesis. 21 studies were included in the studies, which included collected data on 878 patients from retrospective and prospective observational studies. The analysis combined odds ratios, showing an overall effect of 3.1 (95 % confidence intervals 2.2–4.3), indicating that early surgery significantly improves neurological outcomes. The low heterogeneity suggests overall consistency across studies. Although studies such as Goubier et al. (2011) and Socolovsky et al. (2011) showed stronger effects, the results indicate that surgery timing plays a crucial role in neurological recovery, with early interventions being more favorable.

Conclusion. There is a solid foundation to support that early surgical intervention in patients with brachial plexus lesions is a more beneficial treatment than late stage interventions. 

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