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Cost Analysis of Devascularized Digit Injury Management
William Delahoussaye, BS
1, Christopher Branstetter, BS
1, Harel G Schwartzberg, MD
2; Kelly L Babineaux, MD
1(1)LSUHSC-NO School of Medicine, New Orleans, LA, (2)Louisiana State University Health New Orleans, New Orleans, LA
Introduction: This study aims to determine how injury patterns, patient-specific variables, and treatment pathways influence the costs and cost-effectiveness of managing devascularized digits.
Methods: Patients with traumatically devascularized digits between 2019-2024 were queried through our institution's medical record system using ICD-10 codes. Data included demographics, injury characteristics, outcomes, and unadjusted patient charges. Michigan Hand Outcomes Questionnaire (MHQ) scores were estimated through meta-analysis. Data was analyzed with comparative/regression statistics and incremental cost-effectiveness ratios (ICER).
Results: Our analysis included 102 patients, of which 17 had replantation, 23 had revascularization, and 62 had revision amputations. Mean charges were $100,856 (SD $34,083) for replantation, $92,925 (SD $42,022) for revascularization, and $39,830 (SD $67,402) for revision amputations. Failed replants were $6,699 less than successes ($98,491 vs. $105,191;
P=.72), while failed revascularizations were $60,579 more than successes ($132,268 vs. $81,996;
P=.02). Hospital length of stay was the most significant association for cost, with each day costing $15,633 (
P<.001, R
2= 0.77). Leech therapy increased average hospital stay by 6 days for revascularization (
P=.02) and 3 days for replantation (
P=.02). Higher Elixhauser Comorbidity Scores showed a significant positive association with charges (
P=.04,
R2=0.26). The estimated MHQ ICER for replants was $13,974 per MHQ point, with the most cost-effective replant scenario being single non-thumb distal replants ($11,203) and the least cost-effective being single non-thumb crush/avulsion replants ($29,970). Revascularizations had an estimated ICER of $7,793 per MHQ point, with the most cost-effective being multi-digit non-thumb revascularizations (-$1,412) and least cost-effective being multi-digit non-thumb crush/avulsion revascularizations ($27,856).
Discussion: This study identifies key cost drivers and highlights cost-effective treatment options for managing devascularized digit injuries, providing a framework to guide resource allocation and clinical decision-making. Failed revascularization was significantly more expensive than successes, but replantation demonstrated no significant difference. The cost-effectiveness of salvage versus revision varied by procedure and injury classification, with multi-digit revascularization being the most cost-effective. Reducing hospital stays and providing cost-effective procedures should be prioritized to optimize cost-efficiency.
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