Is There an Association Between Industry Payments and the Reported Results after Nerve Repair Using Conduits or Grafts? A Systematic Review.

Abstract

Nerve conduits and allografts are increasingly used for peripheral nerve repairs. Most studies are industry funded and of limited quality, which leaves surgeons potentially vulnerable to commercial influences. We searched for studies published from 2012 until 2024 reporting on outcomes (Medical Research Council Classification [MRCC], static two-point discrimination [s2PD], or Semmes-Weinstein Monofilament [SWMF]) of nerve repairs using conduits or allografts, with at least one author holding a National Provider Identifier. After screening 2,677 titles/abstracts and 156 full texts, we included 41 studies. Most studies were retrospective (85%) and non-comparative (73%). Overall study quality was low to moderate. Nerve-related payments were extracted from the Open Payments Database from 2013 to 2022, with a median of $36,948 (range $0 to $410,486) per author per article. Only 1 study had no nerve-related payments. Among studies with <70% meaningful recovery (MRCC≥S3/M3), 89% (8 of 9) received <$20,000, compared to 28% (8 of 29) in studies achieving ≥70% meaningful recovery. Similarly, among studies with ≥13 mm s2PD, 100% (4 of 4) received <$20,000, compared to 27% (3 of 11) in studies with s2PD<13 mm. Due to limited studies reporting SWMF (n=7), we could not assess its association with nerve-related payments. No association was found between payments and adverse events. Authors receiving greater industry funding are more likely to report more favorable meaningful recovery and s2PD. Awareness of this potential publication bias can help surgeons and patients dispassionately evaluate the rationale for using autograft, allografts and conduits while the evidence remains inconclusive.