Surgical treatment delay in patients with headache disorders and neuralgia correlates with poor postoperative outcome

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2024-12, Vol.99, p.154-159
• Main Authors: Hazewinkel, Merel H.J., Remy, Katya, Knoedler, Leonard, Austen, William G., Gfrerer, Lisa
• Format: Article
• Language: English
• Subjects: Adult; Aged; Decompression, Surgical - methods; Female; Headache Disorders - surgery; Headache surgery; Humans; Male; Middle Aged; Migraine surgery; Nerve decompression surgery; Neuralgia - etiology; Neuralgia - surgery; Retrospective Studies; Surgical outcomes; Surgical treatment delay; Time-to-Treatment - statistics & numerical data; Treatment Delay; Treatment Outcome
• ISSN: 1748-6815; 1878-0539; 1878-0539
• DOI: 10.1016/j.bjps.2024.09.058

Although nerve decompression surgery has proven to be effective in reducing symptoms in patients with head and neck neuralgia and headache disorders, it is currently not part of the treatment algorithms for headache disorders. Therefore, patients wait an average of 20 years from the onset of symptoms to surgery, resulting in high conservative treatment costs ($989,275.65 per patient) and patient morbidity. This study evaluated the clinical impact of treatment delays on surgical outcomes. Overall, 282 patients who underwent nerve decompression surgery at Weill Cornell Medicine and Massachusetts General Hospital between September 2012 and January 2024 were enrolled. Information regarding demographics, onset of symptoms, and headache characteristics was collected using patient surveys. The treatment outcome was evaluated by the percentage of symptom reduction in terms of frequency, duration, and pain intensity. An area under the receiver operating characteristic analysis was performed to determine the optimal timepoint to undergo surgery. Postoperative symptom reduction and time between the onset of symptoms and surgery were negatively correlated (r = −0.22; p