Objective
Digital replantation attempt and success rates have been declining in the U.S. Regionalization of digit replantation has been proposed as a solution to improve both attempt and success rates of these procedures. There is limited information about which criteria could establish a hospital as a center specialized for digit replantation. We analyzed hospital replantation volume and patient factors associated with successful thumb/finger replantation.
Methods
A retrospective study using data from 2008–2012 State Inpatient Data (SID) of Health Care Cost and Utilization project (HCUP) from five states (New York, California, North Carolina, Utah, and Florida) was performed. Generalized Estimating Equation (GEE) method was used to examine the association between patient characteristics and hospital volume and success of thumb/finger replantation. A Receiver Operating Characteristic (ROC) curve and Youden’s J statistic were used to determine annual hospital replant volume cut-off levels for success rates.
Results
There were 3,417 digit amputation injuries, with 631 replant attempts (18%) with an overall thumb/finger replantation success rate of 70%. The hospital annual replantation volume increased the odds of success (OR=1.06, CI: 1.02–1.10). The annual hospital volume of 3 replants was needed to achieve a success rate of 70%.
Conclusions
Practice patterns demonstrate that hospitals with higher annual volume have greater success. Identifying high-volume centers and regionalization of digit replantation should be considered a priority.