Direct Cost and Incidence of Surgically Treated Upper-Extremity Peripheral Nerve Injuries in the United States

PURPOSE: There is a lack of comprehensive data concerning the prevalence of surgically treated peripheral nerve injuries (PNIs) and associated financial burden within the United States. Our purpose was to determine incidence of operatively managed major mixed upper-extremity PNIs and to quantify direct payments for PNI surgical intervention. METHODS: We analyzed administrative data from the Merative MarketScan Commercial Database and the Multi-State Medicaid Database from 2016 to 2022, focusing on adults aged 18-64 with surgically managed PNIs. Incidence, demographics, and direct payments within the first year postsurgery were examined. We used descriptive statistics to summarize payment data and the Mann-Kendall test to assess trends in annual incidence rates from 2016 to 2022. RESULTS: There were 5, 735 patients and 2, 917 patients in the commercial and Medicaid databases, respectively, who met inclusion criteria. The incidence of surgically managed PNIs in the commercial insurance population remained relatively stable, averaging 3. 73 per 100, 000 individuals annually. In the Medicaid population, incidence increased from 2. 8 to 4. 4 per 100, 000 insured individuals between 2016 and 2022. Among patients with 365 days of continuous enrollment, mean total payments over 1 year were 31, 840. 55 in the commercial data set and 27, 517. 00 in the Medicaid data set. At 30, 90, and 180 days, mean total payments were 16, 759. 69, 20, 367. 30, and 24, 537. 40 for commercially insured patients as well as 10, 443. 09, 13, 892. 63, and 17, 536. 23 for Medicaid patients, respectively; these payments represent interval-specific averages, not cumulative payments. CONCLUSIONS: The incidence of surgically treated PNIs is stable in the commercially insured but is rising in the Medicaid-insured population. Of the patients who remained insured in the year after injury, there were ongoing direct payments, highlighting the persistent claims-based financial footprint associated with PNI. These estimates reflect only direct payments and do not assess cost-effectiveness or broader societal costs but serve as a foundation for future investigations. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/Decision Analysis IV.