Emergency Department Wait Time and Treatment of Traumatic Digit Amputation: Do Race and Insurance Matter?

Abstract

Background Little is known about the association between the quality of trauma care and management of non-fatal injuries. We used emergency department (ED) wait times as a proxy for hospital structure, process, and availability of on-call surgeons with microsurgical skills. We evaluated the association between average hospital ED wait times and likelihood of undergoing digit replantation for patients with traumatic amputation digit injuries. We hypothesized that hospitals with shorter ED wait times were associated with higher odds of replantation. Methods Using the 2007-2012 National Trauma Data Bank, our final sample included 12,126 patients. We used regression modeling to first determine factors that were associated with longer ED wait times among patients with digit amputation injuries. Second, we examined the association between ED wait times for this population at a hospital-level and replantation after all types of digit amputation and after complicated thumb amputation injuries (CTAI) only. Results For patients with simple and CTAIs, and patients with CTAIs only longer ED wait times were associated with lower odds of replantation. Additionally, being minority and having no insurance were associated with longer ED wait times; teaching hospitals were associated with shorter ED wait times; and finally, for patients with CTAIs only there were no association between patients’ minority or insurance status and replantation. Conclusions Variation in ED wait times and its effects on treatment of traumatic digit amputation may reflect maldistribution of hand or plastic surgeons with the required microsurgical skills among trauma centers across the U.S.

Finger Replantation Optimization Study (FRONT): Update on National Trends

“…27,28 Furthermore, a 2017 study of emergency department wait times showed that patients with public or no insurance experienced longer wait times, which were associated with lower odds of replantation. 29 These results indicate that a surgeon’s financial incentives may influence surgical decision making, but we also need to consider that patients with a lower socioeconomic status are more likely to have public insurance and thus elect to undergo a revision amputation procedure that costs less and requires shorter recovery, so that they can return to work quickly. 22 In other words, patients with limited financial resources may forego a recommended treatment option.…”

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

“…For example, having no insurance was associated with longer emergency department wait times. 26 In addition, many health insurance plans impose a limit on the number of occupational therapy or physical therapy visits allowed per diagnosis per year and may also limit the duration of an episode of care. Patients in this situation are prone to rationing their therapy visits, which leads to poorer health outcomes.…”

“…24 Last, race can influence logistical access to care for patients, such that being a minority is associated with longer emergency department wait times. 26…”

Atuação do médico cirurgião de mão em microcirurgia no Brasil

“…Microsurgery training is part of the medical residency programs syllabus for hand surgery specialization. 20 21 22 23 24 25 26 27 However, we must ask ourselves if this training is enough for a good practice and if the substrate given to the physician during training is sufficient for the proper, safe performance of such procedures after graduation.…”

“…O treinamento em microcirurgia faz parte da grade curricular nos programas de residência médica para a especialidade de cirurgia da mão. 20 21 22 23 24 25 26 27 Porém, ainda é um questionamento que devemos fazer se este treinamento é suficiente para uma boa prática e se o substrato que foi dado ao médico durante sua formação lhe dá aptidão e segurança suficientes para realizar todos os procedimentos após o término da graduação.…”