Abstract:

Background: 

Traumatic hand and wrist amputations are rare but debilitating injuries. Surgical replantation of the hand provides a unique alternative to revision surgery but requires appropriate access to necessary medical resources. This study aims to understand the national practice of replantation of traumatic hand amputation, and to determine whether disparities exist in accessing surgical treatment.

Methods: 

ICD-10 codes for replantation and revision amputation surgeries were used to gather data from the National Inpatient Sample from 2016-2019. Summary statistics were calculated on demographic, hospital, and outcome variables with sub-analysis performed for effect on replantation and revision rates. 

Results: 

72 patients were identified. The average patient was 35 years old with a strong male predominance (90%). Racial distribution of the cohort roughly mirrored the demographic proportions of race in the US population. 15 (21%) patients underwent replantation. This rate was similar between sexes, races, and income brackets. Hand replantation was primarily performed at large bed size (87%), private not-for-profit (73%), and urban teaching hospitals (94%). The most common insurance status for these patients was private, followed by Medicaid, Medicare, then self-pay. 47 patients underwent revision amputation (65%) with no association between demographic characteristics. Patients remained hospitalized for significantly longer (p = 0.0188) and paid significantly more (p = 0.0014) if replanted. Patients were most frequently discharged home (65%) followed by skilled nursing facilities (18%).  

Conclusion: 

This study describes the current state of hand amputation management and finds no evidence of sociodemographic factors influencing the surgical care provided.