Publications from Dr. Dy
Epidemiologic, societal, and financial impact of brachial plexus injuries
Adult traumatic brachial plexus injuries (BPI) are devastating injuries that predominantly affect young patients in the prime of their productivity. Despite the intense resources dedicated to the treatment of BPI, the scope of impact of BPI had not been clearly delineated. We used a series of administrative data studies and economic models to determine the epidemiologic, societal, and financial effects of BPI. We have identified shortcomings in the current delivery of care for BPI, demonstrating that up to one-third of BPI surgeries are performed more than a year from surgery (despite widespread opinion that these surgeries should be done within 3-5 months from the injury).
- Hong TS, Tian A, Sachar R, Brogan DM, Ray WZ, Dy CJ. Indirect Cost of Traumatic Brachial Plexus Injuries in the United States. J Bone Joint Surg Am. 2019;101:e80(1-7). PMID: 31436660
- Dy CJ, Peacock K, Olsen MA, Ray WZ, Brogan DM. Incidence of surgically-treated adult traumatic brachial plexus injury in the United States. HSS Journal (accepted for publication 11/12/19).
- Dy CJ, Lingampalli N, Peacock K, Olsen MA, Ray WZ, Brogan DM. Direct Cost of Surgically-Treated Adult Traumatic Brachial Plexus Injuries. Journal of Hand Surgery Global Online doi.org/10.1016/j.jhsg.2019.12.001
- Dy CJ, Baty J, Saeed MJ, Olsen MA, Osei DA. A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery. J Hand Surg Am. 2016 Sep;41(9). PMID: 27570225
Understanding the patient experience after brachial plexus injury
Brachial plexus injuries (BPI) cause sudden loss of physical function, leading to substantial effects on every other domain of the patient’s life. In clinical practice, I have noted the impact that the emotional, psychological, and pain components of the injury can have on a BPI patient’s recovery. To better understand the emotional aspects of recovery, we conducted a thematic analysis of BPI discussion groups. This provided a glimpse into the challenges faced by BPI patients, further informing the studies proposed in this application. We used administrative data to characterize the burden of mental health conditions and pain among BPI patients, finding that BPI patients are at higher risk than controls for new-onset depression, new-onset anxiety, and for prolonged opioid prescriptions. Recognizing the influence that coping strategies and social support may have on the ability of patients to adjust to life after BPI, we compared these characteristics in BPI patients and age-matched volunteers. We found that BPI patients exhibit a distinct pattern of coping strategies but have similar support networks. During my K23 career development award, our team conducted qualitative interviews with BPI patients. Patients emphasized the importance of finding a sense of purpose in order to gain acceptance of their impaired function. This finding supported our focus on assessing outcomes in a patient-centered manner.
- Morris M, Daluiski A, Dy CJ. A Thematic Analysis of Online Discussion Boards for Brachial Plexus Injury. J Hand Surg Am. Aug 2016; 41(8):813-818. PMID: 27311862
- Yannascoli SM, Stwalley D, Saeed MJ, Olsen MA, Dy CJ. A Population-Based Assessment of Depression and Anxiety in Patients With Brachial Plexus Injuries. J Hand Surg Am. 2018 Dec;43(12). PubMed PMID: 29789186; PubMed Central PMCID: PMC6242776.
- Dy CJ, Peacock K, Olsen MA, Ray WZ, Brogan DM. Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury. J Hand Surg Am. 2019 Aug. PMID: 31078338.
- Sachar R, Landau AJ, Ray WZ, Brogan DM, Dy CJ. Social support and coping strategies in patients with traumatic brachial plexus injury. HSS Journal. Accepted for publication 6/3/2020.
- Dy CJ, Brogan DM, Ray WZ, Rolf L, Van Voorhis A, Wolfe SW, James AS. What Are the Key Contributors to Patient Satisfaction after Traumatic Brachial Plexus Injury? Poster presentation: American Society of Peripheral Nerve Annual Meeting 2020. (manuscript submitted to J Bone and Joint Surg and currently under peer review)
Improving the assessment and reporting of outcomes after brachial plexus injuries
The complexity and heterogeneity of brachial plexus injuries (BPI) create a challenge when reporting clinical outcomes of treatment. In a systematic review, we demonstrated that the vast majority of papers reporting outcomes after BPI do not include patient-centered outcomes measures. To help address this deficit, our team (led by Scott Wolfe, MD – site PI for HSS in this R01 proposal) created and validated a BPI-specific, patient-reported assessment of function and expectations for recovery. This instrument, the Impact of BPI questionnaire, is the first BPI-specific patient-reported outcome measure. We will use assess its performance characteristics which will be used in this R01 proposal). During my K23 career development award, our team conducted qualitative interviews with BPI patients. The interviewed patients emphasized that recovery after BPI is far more than isolated assessment of muscle strength. These findings reinforce the need to use outcomes instruments that look beyond physical function alone.
- Dy CJ, Garg R, Lee SK, Tow P, Mancuso CA, et al. A systematic review of outcomes reporting for brachial plexus reconstruction. J Hand Surg Am. 2015 Feb;40(2):308-13. PubMed PMID: 25510158.
- Mancuso CA, Lee SK, Dy CJ, Landers ZA, Model Z, Wolfe SW. Expectations and limitations due to brachial plexus injury: a qualitative study. Hand (NY). 2015 Dec;10(4). PubMed PMID: 26568734.
- Dy CJ, Brogan DM, Rolf L, Ray WZ, Van Voorhis A, Buday S, Wolfe SW, James AS. Influence of Knowledge and Expectations on the Patient Experience during Recovery from Traumatic Brachial Plexus Injury. Podium presentation: American Society of Peripheral Nerve Annual Meeting 2020. (manuscript submitted to Journal of Neurosurgery and currently under peer review)
- Dy CJ, Brogan DM, Ray WZ, Rolf L, Van Voorhis A, Wolfe SW, James AS. “Being a patient the rest of my life” – The Influence of Patient Engagement on Recovery after Traumatic Brachial Plexus Injury”. Podium presentation: American Society for Surgery of the Hand Annual Meeting 2020. (manuscript submitted to Journal of Reconstructive Microsurgery and currently under peer review)
Socioeconomic disparities in the delivery of orthopaedic surgery care
Increasing attention has been drawn the presence of disparities in the delivery of healthcare and, specifically, in orthopaedic surgery care. During my NIAMS-funded T32 fellowship, we used administrative data to demonstrate race- and insurance-based disparities in outcomes for fractures in elderly patients. During my KL2 Career Development Award, we found remarkable state-level variation in physician reimbursement for common inpatient orthopedic procedures. We also demonstrated the impact on health policy (specifically, Medicaid expansion under the Affordable Care Act) on total hip and knee arthroplasty, showing an increase in utilization and earlier utilization. There is profound variation in the delivery of orthopedic care to Medicaid beneficiaries in the urban St. Louis market, suggesting that there are opportunities to improve upon these disparities. Our continued work (currently under peer review) examines the socioeconomic predictors of orthopedic utilization (both incidence and timing) among Medicaid patients.
- Dy CJ, Lane JM, Pan TJ, Parks ML, Lyman S. Racial and Socioeconomic Disparities in Hip Fracture Care. J Bone Joint Surg Am. 2016 May 18;98(10):858-65. PMID: 27194496
- Dy CJ, Marx RG, Bozic KJ, Pan TJ, Padgett DE, et al. Risk factors for revision within 10 years of total knee arthroplasty. Clin Orthop Relat Res. 2014 Apr;472(4):1198-207. PubMed PMID: 24347046; PubMed Central PMCID: PMC3940740.
- Lalezari RM, Pozen A, Dy CJ. State variation in medicaid reimbursements for orthopaedic surgery. J Bone Joint Surg Am. 2018 Feb 7;100(3):236-242. PMID 29406345.
- Dy CJ, Brown DS, Maryam H, Keller MR, Olsen MA. Two-State Comparison of Total Joint Arthroplasty Utilization Following Medicaid Expansion. J Arthroplasty. 2018 Dec 22. pii: S0883-5403(18)31220-8. doi: 10.1016/j.arth.2018.12.019. [Epub ahead of print] PubMed PMID: 30642704.
- Dy CJ, Barker A, Brown D, Keller M, Chang P, Yamaguchi K, Olsen MA. Unmet need for total joint arthroplasty in Medicaid beneficiaries after Affordable Care Act expansion. Accepted for publication, May 18 2020. J Bone Joint Surg Am.
- Dy CJ, Tipping AD, Nickel KB, Jiang W, O’Keefe RJ, Olsen MA. Variation in delivery of inpatient orthopedic care to Medicaid beneficiaries within a single metropolitan region. J Bone Joint Surg Am. 2019;101:1451-9 d http://dx.doi.org/10.2106/JBJS.18.01198. PMID: 31436652
Regionalization of orthopaedic surgery care
The transition of American healthcare from “volume to value” has prompted calls for regionalization of orthopaedic care to specialized centers of excellence. In doing so, access to high quality orthopaedic care may not be readily available to all patients, particularly those from lower socioeconomic standing. In this series of papers, we leveraged the strengths of administrative databases to evaluate whether regionalization of care (and associated patient travel) would have undesired consequences. We demonstrated that traveling for care to a regional center of excellence is safe, but patients from lower socioeconomic standing were more likely to utilize hospitals with lower procedure volumes for total joint arthroplasty. These patients were at increased risk for postoperative complications.
- Dy CJ, Marx RG, Ghomrawi HM, Pan TJ, Westrich GH, et al. The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty. J Arthroplasty. 2015 Jan;30(1):1-6. PubMed PMID: 25282073.
- Dy CJ, Bozic KJ, Padgett DE, Pan TJ, Marx RG, et al. Is changing hospitals for revision total joint arthroplasty associated with more complications?. Clin Orthop Relat Res. 2014 Jul;472(7):2006-15. PubMed PMID: 24615420; PubMed Central PMCID: PMC4048404.
- Nwachukwu BU, Dy CJ, Burket JC, Padgett DE, Lyman S. Risk for Complication after Total Joint Arthroplasty at a Center of Excellence: The Impact of Patient Travel Distance. J Arthroplasty. 2015 Jan 19;PubMed PMID: 25639857.
Publications from Dr. Brogan
Brachial Plexus and peripheral nerve injuries comprise a complex constellation of diagnoses and pathologies. However, understanding the etiology of this difficult problem, as well as effective treatment options can help to restore function and relieve pain. Our clinical reviews help to direct the translational research in the lab.
Nerve Injuries and Neuromas
Nerve injuries and neuromas in general comprise a complex constellation of diagnoses and pathologies. However, understanding the etiology of this difficult problem, as well as effective treatment options can help to restore function and relieve pain. I have written several articles on care of brachial plexus injuries, techniques to repair and image peripheral nerves and reconstruct function.
- Dy C, Lingampalli N, Peacock K, Olsen M, Ray W, Brogan DM. “Direct Cost of Surgically Treated Adult Traumatic Brachial Plexus Injuries” J Hand Surg Global Online February 2020.
- Dy C, Peacock K, Olsen M, Ray W, Brogan DM. “Incidence of Surgically-Treated Brachial Plexus Injury in Privately Insured Adults Under 65 Years of Age in the USA”. HSS Journal, January 2020.
- Luzhansky I, Wood M, Brogan DM, Sudlow L, Berezin M. “Perspective: Imaging in the repair of peripheral nerve injury” Nanomedicine 14(20), 2019.
- Dy C, Peacock K, Olsen M, Ray W, Brogan DM. “Frequency and Risk Factors for Prolonged Opioid Prescriptions After Surgery for Brachial Plexus Injury” ˆJ Hand Surg 44(8):662-668 2019.
- Hong T, Tian A, Sachar R, Brogan D, Ray W, Dy CJ. “Indirect Cost of Traumatic Brachial Plexus Injuries in the United States”. J Bone Joint Surg 101(16):e80, 2019.
- Aktas A, Prather H, Brogan D, Colorado D. “Painful Myoclonus Triggered by Lateral Antebrachial Cutaneous Nerve Entrapment at Brachioradialis Muscle: A Case Report”. Am J PM&R,July 29, 2019 Epub ahead of print.
- Brogan DM, Leversedge F. “Surgical Technique and Anatomical Considerations for the Modified L’Episcopo Tendon Transfer” Hand 14(1):34-41, 2019.
- Dy CJ, Aunins B, Brogan DM. “Barriers to perineural scarring: role in treatment of traumatic nerve injury and chronic compressive neuropathy” J Hand Surg 43(4):360-367, 2018.
- Brogan DM, Carofino BC, Kircher MF, Spinner RJ, Elhassan BT, Bishop AT, Shin AY. “Prevalence of Rotator Cuff Tears in Adults with Traumatic Brachial Plexus Injuries” J Bone Joint Surg 96(16):e139, 2014.
- Carofino B, Brogan DM, Kircher M, El Hassan B, Spinner R, Bishop A, Shin A. “Iatrogenic Nerve Injuries During Shoulder Surgery” J Bone Joint Surg 95(18):1667-74, 2013.
- Brogan DM, Kakar S. “Management of Neuromas of the Upper Extremity” Hand Clinics 29(3):409-420, 2013.
- Brogan DM, Bishop AT, Shin AY, Spinner RJ. “Lateral Antebrachial Cutaneous Neuropathy Following Long Head of the Biceps Rupture” J Hand Surg 37(4):673-6, 2012.
Distal Radius Fractures
Distal radius fractures are among the most common upper extremity fractures, resulting in hundreds of millions spent annually on care of these injuries and potentially significant morbidity for patients. The popularity of volar locking plates have revolutionized surgical treatment of these injuries, but these are not without complications. I have been involved in numerous papers looking at both the complications and sequelae of these injuries and the implications of these on surgical indications.
- Obiofuma C, Dy CJ, Lake S, Brogan DM. “Increasing Dorsal Tilt in Distal Radius Fractures Does Not Increase Median Nerve Strain” Journal of Orthopedic Trauma (Submitted)
- Atwood et al, and Brogan DM. “Characterization of the Dorsal Ulnar Corner in Distal Radius Fractures: Implications for Surgical Decision Making. J Hand Surg, published online ahead of print April, 2020
- Shin AY, DeGeorge BR, Brogan DM, Becker HA. Incidence of Complications Following Volar Locking Plate Fixation of Distal Radius Fractures: An Analysis of 647 Cases. Plastic and Reconstructive Surgery 145(4):969-976, 2020.
- Vitale M, Brogan DM, Shin AY, Berger R. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures. J Wrist Surg Mar; 5(1):52-8, 2016.
- Brogan D, Richard M, Ruch D, Kakar S. Management of Severely Comminuted Distal Radius Fractures. J Hand Surg 40(9):1905-1914, 2015.
- Brogan D, Ruch DS. Distal Radius Fractures in the Elderly J Hand Surg 40(6):1217-1219, 2015.