Journal
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
Volume 51, Issue 11, Pages 2532-2540Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.injury.2020.08.024
Keywords
Digit amputation; Digit replantation; Revision amputation; Hospital volume; Surgeon volume; Surgeon experience; Volume-outcome
Funding
- Maintenance Project of the Center for Artificial Intelligence in Medicine [CLRPG3H0 012, CIRPG3H0012]
- Chang Gung Memorial Hospital [CORPG3G0141]
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Background: Traumatic finger amputations cause a substantial burden to health care system. The purpose of this study is to investigate the epidemiology of traumatic finger amputations, the incidence of replantation attempts and to examine the patient, surgeon, and hospital characteristics that were associated with replantation attempts. Methods: We examined 49,469 patients with traumatic digit amputations from the National Health Insurance Research Database (NHIRD) of Taiwan. We used Chi-square, ANOVA tests, and regression analysis to determine the important factors in decision to replant. Results: The replantation rate increased significantly with increased hospital volume (low-volume: 4.7%, medium-volume: 19.1 % and high-volume: 35.9 %). Regional hospitals were more likely to attempt replantation (odds ratio = 1.35). Low-volume hospitals had a replantation failure rate of 11.1 %, medium-volume 19.7 % and high-volume hospitals had 13.8 %. Conclusion: With the national health insurance coverage, hospital volume is a substantial factor to encourage microsurgical-trained staff to perform digit replantation when indicated. The findings from this study will support government initiatives to foster and reward regionalization centers with high to medium case volume of replants to manage this critical function restoring procedure. (C) 2020 Elsevier Ltd. All rights reserved.
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