Cutting Through Silence: Hidden Incidence and Risk Predictors of Peripheral Nerve Injuries in Elective Abdominal Surgeries

Abstract

Background:
Peripheral nerve injuries (PNIs) are a rare but potentially debilitating complication of abdominal surgeries. Despite low reported incidence, emerging data suggests these events are frequently underdiagnosed due to delayed presentation and non-specific symptoms.

Methods:
A retrospective cohort study was conducted across four German surgical centers between January 2021 and December 2023. Medical records of 2,214 adult patients who underwent elective open or laparoscopic abdominal surgery were reviewed. PNIs were defined as new postoperative sensorimotor deficits persisting beyond 6 weeks, confirmed via clinical and electrophysiological assessment.

Results:
Peripheral nerve injury was identified in 63 patients (2.8%). The majority involved the lateral femoral cutaneous nerve (41.3%) and iliohypogastric nerve (33.4%). Laparoscopic procedures accounted for 61.9% of PNIs, despite shorter average operative time. Multivariate regression revealed BMI >30 kg/m² (OR: 2.2, p = 0.003), surgery duration >3 hours (OR: 2.6, p < 0.001), and Trendelenburg positioning >30 minutes (OR: 3.1, p = 0.001) as significant predictors. Only 19% of PNIs were documented prior to discharge; 44% were diagnosed after 30 days via outpatient follow-up.

Conclusion:
Peripheral nerve injuries following abdominal surgeries are more frequent than traditionally reported, with many cases missed during routine inpatient assessment. High BMI, prolonged procedures, and certain surgical positions significantly increase risk. Postoperative follow-up protocols should incorporate neurologic screening to allow early recognition and rehabilitation. Raising surgical awareness about PNI risk may reduce long-term patient morbidity.