Predictors of Neurologic Recovery in Retroperitoneal Hematoma-Associated Femoral Neuropathy: A Systematic Review with Pooled Patient-Level Analysis.

BACKGROUND

Retroperitoneal hematoma (RPH) is a rare but significant condition that can lead to femoral neuropathy (FN). This study aimed to evaluate etiologies, management approaches, and predictors of neurologic recovery in RPH-associated FN.

METHODS

A systematic review was performed according to PRISMA guidelines.

RESULTS

156 studies comprising 209 patients (211 limbs) were included. Etiologies were medication-related hemorrhage (50%), trauma (22%), spontaneous bleeding (11%), post-procedural (5.7%), and combined (10%). Management was conservative (52%), surgical evacuation (37%), percutaneous decompression (5.6%), embolization (1%), and combined (4%). Trauma (OR 12.67, 95% CI 3.28-48.99, p < 0.001) and spontaneous etiology (OR 7.26, 95% CI 1.88-28.04, p = 0.004) were independently associated with higher odds of motor recovery compared with post-medication cases. Percutaneous decompression was associated with lower odds of motor recovery (OR 0.10, 95%CI 0.02-0.63, p =0.014) compared to medical management. Post-procedural and combined etiologies, as well as other treatment modalities, were not significantly associated with motor recovery. Longer follow-up was associated with greater quadriceps strength improvement on the MRC scale (β = 0.05/month, p =0.012). No variables were significantly associated with sensory recovery in primary analysis. Sensitivity analysis of patients with follow-up of 12+ months showed trauma as the only variable with significantly higher odds of motor and sensory recovery. Hematoma size, location and time to presentation were not predictive of outcomes.

CONCLUSIONS

FN due to RPH occurs predominantly in anticoagulated patients and is usually managed conservatively. Etiology appears to primarily influence motor recovery. These findings support individualized, largely nonoperative management.