Racial Variation in Treatment of Traumatic Finger/Thumb Amputation

Abstract

Background Traumatic finger/thumb amputations are some of the most prevalent traumatic injuries affecting Americans each year. Rates of replantation after traumatic finger/thumb amputation, however, have been steadily declining across U.S. hospitals, which may make these procedures less accessible to minorities and vulnerable populations. The specific aim of this study was to examine racial variation in finger replantation after traumatic finger/thumb amputation. Methods Using a two-level hierarchical model, we retrospectively compared replantation rates for African-American patients with those of Whites, adjusting for patient and hospital characteristics. Patients younger than 65 with traumatic finger/thumb amputation injuries who sought care at a U.S. trauma center between 2007 and 2012 were included in the study sample. Results We analyzed 13,129 patients under 65 years of age with traumatic finger/thumb amputation. Replantation rates declined over time from 19% to 14% (p = 0.004). Adjusting for patient and hospital characteristics, African-Americans (OR=0.81; CI: 0.66–0.99; p = 0.049) were less likely to undergo replantation procedures than Whites, and uninsured patients (OR=0.73; CI: 0.62–0.84; p < 0.0001) were less likely than those who were privately insured. Conclusions Despite advancements in microsurgical techniques and the increasing use of reconstructive surgery in other fields, finger/thumb replantation rates are declining in the U.S. and vulnerable populations are less likely to undergo replantation after amputation injuries. Regionalization of care for these injuries may not only provide a higher quality care but also reduce variations in treatment.

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

“…Despite evidence suggesting that replantation is associated with benefits in function, emotional well-being, and economic productivity, the rates of replantation continue to decrease across the US. 7 , 8 , 9 , 18 This decrease in replantation rates is especially concerning for patients who have sustained traumatic thumb amputation because 40% of hand function is achieved with the thumb. 19 , 20 In an analysis of the National Electronic Injury Surveillance System, Bureau of Labor Statistics, and National Inpatient Sample databases, the number of digit replantations decreased by more than 50% between 2001 and 2011 in spite of a stable incidence of traumatic digit amputations.…”

“… 5 Despite the added benefits associated with replantation, there has been a decreasing trend in the rates of replantation attempts and subsequent success. 7 , 8 , 9 In the US, replantation success rates have decreased from approximately 75% in the early 2000s to approximately 66% from 2010 to 2012. 8 In contrast, in countries such as China and Japan replantation success rates are approximately 90%.…”

Epidemiology of Finger Amputations in the United States From 1997 to 2016

“…Interpretation of this database is inherently limited by our inability to control for confounding factors such as insurance status, as well as our limited access to final treatment decision after admission, but there was evidence in the literature of a racial disparity in the treatment of finger amputations. An analysis of the National Trauma Database by Mahmoudi et al 29 comparing replantation rates of African American patients with those of whites while adjusting for hospital and patient characteristics including insurance status and injury severity found that African American patients were less likely than their white counterparts to undergo replantation. Further investigations are indicated regarding the observed racial disparity in admissions after amputation.…”

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

“…1,2,24 With the lower rate of pediatric replantation performed across the country as shown within our article and lower reported success of digit replantation in recent years, some researchers have proposed the need for regionalization of replant centers to be staffed by highly competent replantation surgeons to maximize the success of these difficult operations. 1,11,12,27 A retrospective study by Brown et al 15 using the 2008 and 2012 State Inpatient Databases from the HCUP demonstrated increased odds of success for replantation in hospitals with higher annual replantation volume. Overall, a continued evaluation of maximizing replantation success, especially in the pediatric population, should be addressed whether through increase in resources to training a subset of hand surgeons with strong microvascular skills for replantation and/or forming regionalization centers to specialize in replantation to establish a higher success rate of pediatric digit replantation.…”

“…Nonetheless, the frequency of microsurgery and replantation procedures has decreased in the United States over the past 2 decades as a result of multiple factors, including declining reimbursements, availability of microsurgery services, inconsistency of outcomes, and time commitment. 10-12 Between 2000 and 2011, the proportion of pediatric patients who underwent replantation has varied between 16% and 40%. 4,10 Conversely, revision amputation offers the benefits of a quicker healing course, shortened or lack of hospitalization, decreased need for postoperative therapy, and lower cost.…”