Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection, Outcomes, and Cost

Abstract

Background: Indications for replantation following traumatic digit amputations are more liberal in the pediatric population than in adults, but delineation of patient selection within pediatrics and their outcomes have yet to be elucidated. This study uses a national pediatric database to evaluate patient characteristics and injury patterns involved in replantation and their outcomes. Methods: The Healthcare Cost and Utilization Project Kid’s Inpatient Database was queried for traumatic amputations of the thumb and finger from 2000 to 2012. Participants were separated into those who underwent replantation and those who underwent amputation. Patients undergoing replantation were further divided into those requiring revision amputation and/or microvascular revision. Patient age, sex, insurance, digit(s) affected, charges, length of stay, and complications were extracted for each patient. Results: Traumatic digit amputations occurred in 3090 patients, with 1950 (63.1%) undergoing revision amputation and 1140 (36.9%) undergoing replantation. Younger patients, those with thumb injuries, females, and those covered under private insurance were significantly more likely to undergo replantation. Cost, length of stay, and in-hospital complications were significantly greater in replantation patients than in those who had undergone amputation. Following replantation, 237 patients (20.8%) underwent revision amputation and 209 (18.3%) underwent vascular revision, after which 58 required revision amputation. Risk of revision following replantation involved older patients, males, and procedures done recently. Conclusions: Pediatric patients who underwent replantation were significantly younger, female, had thumb injuries, and were covered by private insurance. Our findings demonstrate that in addition to injury factors, demographics play a significant role in the decision for finger replantation and its outcomes.

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

“…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.…”

Development and external validation of a prediction model for digit replantation failure after traumatic amputations based on a prospective multicenter cohort

“…While revision amputation is less costly and less complex, replantation is still an important treatment for patients with traumatic digit amputation, in that it can partially restore the function and appearance of the affected finger 3 . However, this sophisticated surgery requires highly experienced hand surgeons and patients require long or extended hospitalization after surgery 9 , 10 . Owing to microsurgical advancements, the success rate of digit replantation reached more than 80% 11 – 13 .…”