Predictive Factors for Replantation in Patients with Traumatic Digit Amputations:
A 10-Year Review of the National Trauma Data Bank
Introduction:
•Traumatic digit amputations typically occur in younger patients working in manual labor industries, significantly affecting their lifestyle1
•Digit replantation rates have precipitously declined in recent years2-4
Objectives:
•Investigate temporal trends in digit replantation across trauma centers nationally
•Identify factors predictive of attempted replantation following traumatic digit amputation
Hypotheses:
•Rates of digit replantation have continued to decline nationally
•Mechanism of action (MOA) and insurance are implicated in the decision to replant
Methods:
•Dataset: National Trauma Data Bank (NTDB),
years 2010-2019
•Inclusion criteria: ICD codes for traumatic digit amputations and reattachment of digits
•Data collected: demographics, comorbidities, emergency department vital signs, trauma MOA
Analyses:
•Pearson correlation coefficients to determine change in replantation rate across 10 years
•Univariate testing for variable progression to multivariate testing (selection threshold p<0.25)
•Multivariate logistic regression to identify factors associated with attempted replantation (p<0.05)
Results:
•Cohort size: 55,084 patients with 66,274 amputated digits
•Replantation attempted on 3,896 patients (7.1%) and 4,326 digits (6.5%)
•Significant decline in replantation rates (r = -0.95, p < 0.001), with relatively steady success rates (r = 0.11, p > 0.05)
•
•Descriptive Statistics: Significant differences in patients’ age, BMI, race, and length of stay, as well as hospital trauma level and teaching status between replantation and no replantation groups
•Multivariate Regression: Older age, Hispanic/Latino ethnicity, and Level II/III trauma centers associated with lower odds of replantation.
Payment out-of-pocket or with Medicare, as well as injuries due to motor vehicles, nature/environment, firearms, and struck by/against associated with lower odds of replantation
Discussion:
•American College of Surgeons mandate for microvascular services at Level I trauma centers has had little influence on replantation rates5
•Replantation patients are younger, have lower BMIs, present to Level I trauma centers, and have longer lengths of stay
•Consistent with literature data, race, ethnicity, insurance, and hospital characteristics contribute to the decision for replantation or revision amputation2,6
Conclusions:
•One of the largest cohorts of digit replantation data to date
•Rates of replantation have declined, despite a relatively constant success rate
•Ethnic and insurance disparities exist in digit replantation
Future Directions:
•Identify variables predictive of successful replantation in this cohort
References:
1. Bastidas N, Cassidy L, Hoffman L, Sharma S. A Single-Institution Experience of Hand Surgery Litigation in a Major Replantation Center. Plast Reconstr Surg. 2011 Jan;127(1):284.
2. Friedrich JB, Poppler LH, Mack CD, Rivara FP, Levin LS, Klein MB. Epidemiology of Upper Extremity Replantation Surgery in the United States. J Hand Surg. 2011 Nov 1;36(11):1835–40.
3. Hustedt JW, Bohl DD, Champagne L. The Detrimental Effect of Decentralization in Digital Replantation in the United States: 15 Years of Evidence From the National Inpatient Sample. J Hand Surg. 2016 May 1;41(5):593–601.
4. Reavey PL, Stranix JT, Muresan H, Soares M, Thanik V. Disappearing Digits: Analysis of National Trends in Amputation and Replantation in the United States. Plast Reconstr Surg. 2018 Jun;141(6):857e.
5. American College of Surgeons. Resources for Optimal Care of the Injured Patient. Chicago, IL; 2013.
6. Squitieri L, Reichert H, Kim HM, Steggerda J, Chung KC. Patterns of surgical care and health disparities of treating pediatric finger amputation injuries in the United States. J Am Coll Surg. 2011 Oct;213(4):475–85.
