Trends in Hand and Digit Traumatic Amputations and Replantations Over a Decade: An Evaluation of Two National Databases from 2010-2019
Theodore E. Habarth-Morales, BS, 1LT, USAR1,2, Mehdi S Lemdani, BA2, Tien Thuy Nguyen, BS2, Harrison D Davis, BS3, Robyn B Broach, PhD2, Arturo J Rios-Diaz, MD2 and Ines C. Lin, MD2, (1)Thomas Jefferson University, Philadelphia, PA, (2)University of Pennsylvania, Philadelphia, PA, (3)Temple University, Philadelphia, PA
Introduction: Trends of hand and digit replantation decreased in the first decade of the 21st century according to previous studies. These trends, along with literature indicating a decreased preference to replanting amputated hands or digits, have important implications in plastic surgery education and clinical practice management. Recent changes such as the establishment of the National Hand Trauma Center Network have attempted to increase the proportion of replants. A national level analysis of these trends has not been performed in the last decade, hence we aimed to characterize trends in hand/digit amputation and replantation across the United States utilizing multiple national databases.
Materials & Methods: The American College of Surgeonâ€™s National Trauma Databank (NTDB) and Healthcare Cost and Utilization Projectâ€™s Nationwide Readmission Database (NRD) were queried for all instances of hand (below elbow) or digit amputation from 2010-2019. The temporal trends were analyzed using risk-adjusted Poisson regression in addition to trends in the disposition of cases from the emergency department (ED) within the NTDB.
Results: 72,744 finger amputations were identified of which 8,485 (11.6%) had an attempted replantation. The annual incidence of finger amputations decreased significantly throughout the study period (P<0.001), though the rate of attempted replantation as a proportion of amputations also decreased significantly in both databases (P<0.001). In terms of traumatic hand amputations, 13,359 were identified and 604 (4.5%) had attempted replantation. The incidence of traumatic hand amputation (P<0.001) decreased significantly over the decade (P<0.001; FIGURE 1A). There was a decrease in the incidence of hand replantation in the NTDB (P<0.001) though there was no significant trend in the NRD (P=0.076; FIGURE 1B). Within the NTDB, the rate of hospital admission decreased significantly from 84.8% to 75.1%, while the proportion of patients being discharged after treatment in the ED increased from 6.4% to 14.1% (all P<0.001; FIGURE 1C).
Conclusions: In continuation of the trends observed in the first decade of the century, the 2010s appear to have seen decreased rate of finger and hand replantation after traumatic amputation. Additionally, an increasing proportion of traumatic hand and digit amputations are managed in an outpatient setting rather than receiving admittance, further signaling a more conservative approach to these injuries is growing in prevalence.
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