Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation

Billig, Jessica I.; Nasser, Jacob S.; Cho, Hoyune E.; Chou, Ching-Han; Chung, Kevin C.

doi:10.1001/jamanetworkopen.2020.36297

Cited by 10 publications

(9 citation statements)

References 36 publications

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“…In comparison, Billig et al found that interfacility transfer following traumatic thumb amputation was associated with increased odds of replantation attempt and increased replantation success. 17…”

Section: Discussionmentioning

confidence: 99%

“…All studies included in this review concluded that following finger amputation, the odds of replantation attempt and replantation success are significantly less for uninsured patients compared with those with private insurance. 17,[20][21][22][23] In addition, having noncommercial insurance was associated with increased odds of amputation following burn injury. 24 Insurance status has been demonstrated to affect the type of skin graft one will receive following hand burns.…”

Section: Patient-related Barriersmentioning

confidence: 99%

“…16 In comparison, Billig et al found that interfacility transfer following traumatic thumb amputation was associated with increased odds of replantation attempt and increased replantation success. 17 Insurance status. We have identified a trend that those with noncommercial or no insurance are less likely to get an appointment with a hand specialist or to receive treatment.…”

Section: Patient-related Barriersmentioning

confidence: 99%

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Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Kohan

Mangan

Patel

2022

Hand (New York, N,Y.)

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Background: Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation. Methods: The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence. Results: Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature. Conclusions: This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.

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Section: Discussionmentioning

confidence: 99%

Section: Patient-related Barriersmentioning

confidence: 99%

Section: Patient-related Barriersmentioning

confidence: 99%

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Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Kohan

Mangan

Patel

2022

Hand (New York, N,Y.)

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“…Rather, it occurs at the discretion of the receiving physician and upon approval by an accepting physician after a telephone discussion regarding the needs of the patient and the potential of the receiving hospital to meet those needs. Willingness of a receiving specialist to accept transfer of a patient varies widely by institution, speciality, and individual, as do patient outcomes after transfer 12–14 …”

Section: Introductionmentioning

confidence: 99%

“…Willingness of a receiving specialist to accept transfer of a patient varies widely by institution, speciality, and individual, as do patient outcomes after transfer. [12][13][14] Patients living with Alzheimer's disease and related dementias (ADRD) visit the ED an average of 1.5 times per year, surpassing the number of visits for patients with cancer, ischemic heart disease, or heart failure. 15,16 They are particularly vulnerable to poor outcomes after any care transition, including interhospital transfer, because of medication errors, environmental changes that can negatively impact cognition, and the physical transition itself.…”

Section: Introductionmentioning

confidence: 99%

Impact of interhospital transfer on patients with Alzheimer's disease and other related dementias

Glober,

LaShell,

Montelauro

et al. 2023

Alz & Dem Diag Ass & Dis Mo

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Older adults are often transferred from one emergency department (ED) to another hospital for speciality care, but little is known about whether those transfers positively impact patients, particularly those with Alzheimer's disease and other related dementias (ADRD). In this study we aimed to describe the impact of interhospital transfer on older adults with and without ADRD. In a retrospective review of electronic medical records, we collected data on demographics, insurance type, initial code status, intensive care, length of stay, specialist consult, procedure within 48 hours, and discharge disposition for older adults (years). We included older adults with at least one ED visit, who were transferred to a tertiary care hospital. With logistic regression, we estimated odds of death, intensive care stay, or procedure within 48 hours by ADRD diagnosis. Patients with ADRD more often received a geriatrics (p < 0.001) or palliative care consult (p = 0.038). They were less likely to be full code at admission (p < 0.001) or to be discharged home (p < 0.001). Patients living with ADRD less often received intensive care or a procedure within 48 hours of transfer (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.22–2.88). Patients with ADRD were less likely to receive intensive care unit admission or specialist procedures after transfer. Further study is indicated to comprehensively understand patient‐centered outcomes.

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Indications for replantation and factors that predict success

Bregman,

Nicholson

2023

Eur J Orthop Surg Traumatol

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Since the advent of replantation techniques, there has been uneven progress in terms of success—even considering whether success is defined as continued perfusion of the digit or long term functional outcomes. Early enthusiasm and success have not been maintained despite increasing familiarity with microsurgical techniques and greater understanding of how to optimize outcomes for the individual components of replantation such as tendon repair, nerve repair, and osteosynthesis. Practitioners participating in the care of patients undergoing replantation should be familiar with the history and current understanding of both the indications and contraindications for the procedure, post-operative rehabilitation, and factors contributing to functional outcomes. A review of the literature from the first publications on the topic demonstrates evolution in practice and understanding of which patients should be indicated for replantation. Indications can be considered in three broad categories: injury factors, patient factors, and care context factors. These factors intersect with one another and can inform the surgeon pre-operatively regarding the most likely outcome for a given patient. This insight is critical to discuss pre-operatively with the patient in order to make a shared decision about how to manage their injury.

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Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation

Abstract: This cross-sectional study examines associations of interfacility transfer and patient and hospital characteristics with thumb replantation attempts and success after traumatic thumb amputation.

Cited by 10 publications

References 36 publications

Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Impact of interhospital transfer on patients with Alzheimer's disease and other related dementias

Indications for replantation and factors that predict success

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