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Replantation Decisions Are Independent of Social Determinants of Health: A Retrospective Study
Julien JS Levy, B.S.
1, Jasnoor Singh, BS
1, Yucheng Tian, MSE
2, Stephen WP Kemp, Ph.D.
2; Rachel Hooper, MD
2(1)University of Michigan Medical School, Ann Arbor, MI, (2)University of Michigan, Ann Arbor, MI
Introduction: The Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) are measures used to quantify community-level social determinants of health (SDOH), which can influence healthcare access and outcomes. Higher SVI and ADI scores are associated with poorer surgical outcomes, including increased complication rates, longer hospital stays, delayed access to care, and increased severity of disease at presentation. However, the relationship between SVI/ADI and digital replantation is less well studied. This study aimed to evaluate whether patients from communities with higher SVI or ADI scores demonstrate a lower likelihood of attempted replantation following traumatic hand or digit amputation.
Materials and Methods: We identified patients with traumatic thumb, hand or digit amputations between January 2018 and December 2022 at a single academic medical center in the Midwest. Our primary outcome included an analysis of the rate of thumb, hand, or digit replantation attempts, in relation to SVI or ADI scores. Secondary outcomes included the relationship between replantation rates and patient demographic characteristics, insurance type, medical comorbidities, and surgeon subspecialty.
Results: After applying our inclusion and exclusion criteria, we identified 213 patients who sustained a traumatic thumb, hand or digit amputation; 42 (19.7%) underwent replantation and 171 (80.3%) underwent revision amputation. The mean age of our cohort was 40.4 years, and the majority were male (85%). Eighty-six percent of patients were White and 40.4% Private Insurance. SVI and ADI were not significant predictors of replantation (SVI: OR = 1.00, 95% CI: 0.77-1.27 and ADI: OR = 1.00, 95% CI: 0.996-1.001). Multivariate analysis revealed that injury level was the most clinically significant predictor of replantation attempt, with hand (OR: 2.44, 95% CI: 1.13-5.27) and thumb amputations (OR: 1.19, 95% CI: 1.01-1.40) more likely to be replanted than finger amputations. Surgical subspeciality predicted replantation attempt; orthopedic-trained surgeons were less likely to attempt replantation (OR: 0.87, 95% CI: 0.78-0.98) than plastic surgeons.
Conclusions: In patients with thumb, hand or digit amputations, replantation attempt was driven by the mechanism and level of injury rather than unfavorable social determinants or high SVI and ADI scores in this single-center study.
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