Injury Diagnosis

We believe that one of the most important questions to ask your doctors is how much experience they have with brachial plexus and Erb's injuries both in children and adults. If the answer is vague or they don't know how many of these cases they see or operate on each week, this should be cause for concern. Remember , children with brachial plexus injuries are completely different from adults and require different management.

Although The Nath Brachial Plexus Institute itself is new in existence, Dr. Nath has treated thousands of children and adults in the last 8 years. He has developed and invented several new operations and therapy protocols for treatment of these injuries.

Ask also how many total brachial plexus operations in children are done per week and per year, and how many have been done in total. It is well established that the more numbers of a surgical procedure done, the better the patient's outcome, with fewer deaths and complications.

This seems obvious, and the principle has been shown in numerous studies:

• Witt, PD et al. The effect of surgeon experience on outcome following palatoplasty.Plastic and Reconstructive Surgery 102:1375, 1998;
• Witt, PD et al. The effect of surgeon experience on outcome following palatoplasty.Plastic and Reconstructive Surgery 102:1375, 1998;
• Devlin HB. Audit and the quality of clinical care. Annals of the Royal College of Surgeons 72(Suppl.1):3, 1990;
• Lee JAH et al. Fatality from three common surgical conditions in teaching and non-teaching hospitals. Lancet ii: 785, 1957;
• Wennberg JE et al. Mortality and reoperation following prostatectomy. Journal of the American Medical Association 257: 933, 1987;
• DeVries BC et al. Prospective randomized multi-center trials of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer. Results after 5-7 years. British Journal of Surgery 70: 701, 1983;
• Hannan EL et al. Investigation of the relationship between volume and mortality for surgical procedures performed in New York state hospitals. Journal of the American Medical Association 262: 503, 1989;
• Roos LL et al. Centralization, certification and modeling: Readmissions and complications after surgery. Medical Care 24: 1044, 1986.

Ask what the evaluating team consists of. Is it a multidisciplinary approach with specialists from many relevant fields, or does it consist only of surgeons or only of medical doctors?

At The Nath Brachial Plexus Institute , our multi-specialty team will consist of a pediatric neurologist, a pediatric reconstructive microsurgeon, a pediatric orthopedic surgeon, a pediatric neurosurgeon, a pediatric occupational therapist and a research coordinator, What is the commitment of the program to research and education? What training do the physicians have?

We believe that improving the outcome of brachial plexus injuries will depend on basic science and clinical innovations that require a commitment to research. Our research endeavors range from outcome studies and epidemiology of brachial plexus injuries to nerve gene therapy studies supported by the National Institutes of Health.

• What are the results of surgery performed by the program?
• What is the complication rate?

Our patients have an overall improvement rate of greater than 90% and we have to date not had any patient become worse after the surgery.