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Disappearing Digits: Analysis of National Trends in Amputation and Replantation
Patrick L. Reavey, MD, MS; Marc Soares, MD; Vishal Thanik, MD
Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York, NY

Introduction: Bellevue Hospital Center, one of two designated replantation centers in New York City, has performed significantly fewer replantations in the past several years. A study of three national databases was performed to evaluate this trend, its possible etiology, and health care implications on a national level.

Materials & Methods: The Consumer Product Safety Commissionís National Electronic Injury Surveillance System (NEISS) database and the Bureau of Labor Statistics Occupational Injuries and Illnesses (BLS) database were queried for cases with a diagnosis of finger amputation over available years from 2000-2010. The National Inpatient Sample (NIS) database of the Health Care Utilization Project was evaluated for inpatient discharges with a primary procedure of finger or thumb replantation from 2009-2011.

Results: Amputations: NEISS national estimates for emergency room visits with a diagnosis of a finger amputation have not significantly changed since 2001 (26,668 in 2001 vs. 24,215 in 2010). However, detailed analysis of the specific sample cases indicates that in 2010, 53% of these injuries were fingertip or partial amputation injuries. Examination of BLS data demonstrated that the estimated incidence rate of workplace injuries resulting in finger amputation has decreased 40% from 2000-2010.

Replantations: The NIS weighted national estimate for the number of finger replantations performed in 2011 was 445, more than a 50% decrease from the 930 replantations in 2001. In 2001, 78 hospitals in the NIS sample performed one or more finger replantation, with 62.8% only performing one procedure. In 2009, only 51 hospitals performed one or more finger replantation, with 62.7% only performing one. 44 additional hospitals in the 2009 sample were enrolled in and performed a replantation during at least one year between 2001-2008, but not during 2009. In both 2001 and 2009, the majority of replantation hospitals were considered large (74% vs. 78%, p = 0.6) and located in an urban environment (87% vs. 92%, p=0.56).

Conclusions: The recent decrease in replantations observed at Bellevue Hospital is consistent with national trends according to the NIS. BLS data suggest that this may be due to fewer power tool or machinery-related workplace amputations. With this decline, fewer hospitals and surgeons are regularly performing these complex operations. This finding supports the formation of specialized regional replantation centers where patients can be evaluated and treated by experienced surgeons to achieve optimal outcomes. Additionally, the effect of decreased exposure to replantation surgery on the training of future hand surgeons must be considered.

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