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American Association for Hand Surgery

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Replantation of upper extremity outcomes following traumatic injuries: A Study on the National Trauma Databank
Charalampos Siotos, MD1, Sydney R. Horen, BA2, Shelby Graham, BS3, Todd Beck, PhD1, Jafar Hasan, MD4, Mark A Grevious, MD, MBA, FACS5 and Matthew Doscher, MD4, (1)Rush University Medical Center, Chicago, IL, (2)RUSH UNIVERSITY medical center, Chicago, IL, (3)Rush Medical College, Chicago, IL, (4)Cook County Health System, Chicago, IL, (5)Cook County Health and Hospitals System, Chicago, IL

Introduction
Traumatic upper extremity amputations may be managed with replantation which has been shown to significantly improve functional and aesthetic outcomes in selected cases. Multiple factors, including hospital characteristics, may influence the success of upper extremity replantation. The aim of this study is to evaluate the influence of these factors of replantation success.
Methods
Query of the National Trauma Databank from 2004 to 2016 was performed for all patients suffering from traumatic upper extremity amputations who underwent replantation. Patient demographics, hospital characteristics, time to replantation, and outcomes were assessed. Logistic regression was performed.
Results
We identified 909 patients, 14.3% females and 85.7% males, who underwent upper extremity replantation following traumatic amputation. Acute replantation failure was reported in 20 cases (2.2%). Replantation procedures were shown to be more successful at hospitals with >400 beds (OR = 4.795; 95 percent CI, 1.66 to 13.81). Median time to replantation was 4.6 hours in successful procedures, and 2.5 hours in unsuccessful procedures. Time to replantation did not affect replantation success (OR = 1.006; 95 percent CI, 0.995 to 1.016).
Conclusion
Most patient demographic variables and comorbidities as well as hospital characteristics do not affect replantation success. While these variables may influence time to surgery, time to surgery itself is not an independent factor in predicting replantation success, while larger hospital size may be associated with better procedure outcomes.


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