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The Correlation of Traumatic Hand Injury with Distance to Treatment
Joshua Anthony1; Hunter J. Rooks, MS2; Kevin W. Sexton, MD3; Andre P. Marshall, MD, MPH4; Oscar Guillamondehui, MD, MPH4; Jesse Ehrenfeld, MD, MPH3; Bruce Shack, MD3; Wesley Thayer, MD, PhD4
1Meharry Medical College, Nashville, TN; 2University of Tennessee Health Science Center, Memphis, TN; 3Vanderbilt University, Nashville, TN; 4Vanderbilt University Medical Center, Nashville, TN

Background: Hand trauma is the most frequently treated injury in emergency departments, however emergency coverage by hand specialists is limited requiring patients to travel various distances for definitive care. We hypothesize that complications after hand surgery will increase with the distance a patient has to travel for definitive care.
Methods: We examined all patients undergoing operative intervention for hand injuries at a regional medical center in the state of Tennessee from the years 1999-2011. Combing data from the TRACS database and using patient zip codes we extrapolated distance from place of injury or transfer site to the regional medical center. Distances were calculated with computer mapping software by using the shortest geographical distance and rounding to the nearest integer. Complications were defined using appropriate ICD-9 and CPT codes.
Results: Of the 1004 patients identified over the study period, 98 (9.7%) required revisonal surgery. These complications occurred in 36 (3.6%) patients from contiguous counties to the study hospital (Greater metropolitan area or, GMA). Another 62 (6.2%) occurred in patients from outside the greater metropolitan area, including other states. As distance of patient county of residence from the study center increased, the percent of patients with complications increased (p < 0.0001)
Conclusion: This study suggests that complications increase as distance from a center capable of definitive operative intervention for hand injury increases. Limitations in care availability in Tennessee are not specific to hand surgery. If the trend toward poorer outcomes as a result of limited local care availability extends to other specialties, this could have implications regarding health care realignment. Specifically, for patients with complex injuries or conditions that will be referred to centralized flagship hospitals, potential increases in patient travel may limit outcomes.


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