A Population-Based Study of Replantation After Traumatic Thumb Amputation, 2007-2012

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• 作者：Elham Mahmoudi ; PhD ; MS^&lowast ; ; ^{Mahmoudi@med.umich.edu} ; Helen E. Huetteman ; BS^&lowast ; ; Kevin C. Chung ; MD ; MS^&dagger ;
• 关键词：Amputation ; insurance ; replantation ; thumb ; trauma
• 刊名：The Journal of Hand Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：42
• 期：1
• 页码：25-33.e6
• 全文大小：700 K
• 卷排序：42

文摘

The recommended surgical treatment after thumb amputation is replantation. In the United States, fewer than 40% of thumb amputation injuries are replanted, and little is known about factors associated with the probability of replantation. We aimed to investigate recent trends and examine patient and hospital characteristics that are associated with increased probability of attempted thumb replantation. We hypothesized that higher-volume teaching hospitals and level-I trauma centers attempted more replantations.MethodsWe used 2007–2012 data from the National Trauma Data Bank. Our final sample included 2,206 traumatic thumb amputation patients treated in 1 of 365 centers during the study period. First, we used a 2-level hierarchical logistic model to estimate the odds of replantation. In addition, we used a treatment effect estimation method, with the inverse propensity score weighting to examine the difference in thumb replantation if the only variation among patients was their presumptive payer.ResultsThere was a higher probability of attempted replantation at teaching hospitals than nonteaching hospitals (odds ratio [OR], 1.40). Patients were less likely to undergo replantation at a level II (OR, 0.53) or a level III (OR, 0.33) trauma center. The uninsured were less likely to undergo replantation (OR, 0.61) than those with private insurance.ConclusionsHaving insurance coverage and being treated in a high-volume, teaching, level-I trauma hospital increased the odds of replantation after traumatic thumb amputation. Regionalization may lead to a higher number of indicated cases of replantation actually being attempted.Type of study/level of evidenceTherapeutic II.