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American Association for Hand Surgery

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Tertiary hospital transfers for evaluation and treatment of the infected hand: A healthcare cross-sectional analysis
Paul Ray Clark, MD1, Dean W Smith, MD2 and Ryan J Warth, MD1, (1)University of Texas Health Science Center at Houston, Houston, TX, (2)McGovern Medical School, Houston, TX

Background: Emergency center and hospital assessment for hand infections is common. However, a portion of these patients are transferred to tertiary hospitals for definitive care. Previous publications regarding hand patient transfers focus primarily on traumatic injuries or in combination with infections; many are single institution experiences. To date there has not been a large-scale healthcare analysis regarding patients transferred for hand infections. The purpose of our investigation was to analyze patients transferred in the state of Texas for hand infections.
Methods: A cross-sectional analysis was performed using the Texas Healthcare Information Collection Database between 2015-2019. Data was queried for outpatient Current Procedure Terminology (CPT) codes and ICD 10 codes associated with infections distal to the elbow. Statistical analyses were performed for patient demographics, zone of residence, primary insurance, day of week transfers initiated, length of stay (LOS), and management. Surgeries were categorized based on the ICD-10 procedure categories (drainage, excision, extirpation, extraction, and release).
Results: 3,581 patients were transferred for hand infections. Patients primary insurance was self-pay 34.7% (453), private 30.4% (397) or Medicare/Medicaid 28.5% (396). 2,493 procedures were performed in 1,692 (50.5%) of transferred patients, 42% (557) were aged 19-44 years. Patients' self-reported region of residence was metropolitan 79.3% (1,995), micropolitan 10.5% (265), rural 10.1% (255), while nearly all patients were transferred to metropolitan region hospitals 96.9% (1,265) of the time (p<0.001). Subcutaneous tissue was the most common operative layer 48.4% (1,127/2,493 total procedures). The most common procedures were drainage 46.7 % (1,163) or excision 41.1% (1,024). Operative patients' LOS was 7.7 ± 10.3 days, versus 14.9 ± 16.5 days for non-operative (p<0.001). Weekend transfers had decreased average LOS relative to weekday (mean 7.7 ± 9.5 days versus 12.3 ± 15.2 days; p<0.001), but a 94.7% increased odds of operation (OR=1.947 [95% CI, 1.652-2.294]; p<0.001).
Conclusion(s) Many patients are transferred to tertiary centers within Texas for hand infections annually. Roughly 2/3 of transferred hand infection patients carried private or medicare/medicaid insurances and only 1/3 were self-pay. Patients managed with operations most frequently had a drainage procedure. Operative patients had a shorter average LOS especially those transferred on a weekend. These findings are important for healthcare systems managing transferred hand infection patients as they identify/describe the patient cohort, expected management, LOS and insurance status'.


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