Effects of non-surgical factors on digital replantation survival rate: a meta-analysis

Ma, Zhichao; Guo, Feng; Qi, Jun; Xiang, Wenpei; Zhang, J.

doi:10.1177/1753193415594572

Cited by 51 publications

(53 citation statements)

References 30 publications

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“…8,21–23 Similar to our findings, non-surgical patient factors have not been shown to have significant influence on success. 19 Our study revealed payer type affected the outcomes of replantation. Interestingly, those with Medicaid and Medicare had improved odds for success in comparison to those with private payer.…”

Section: Discussionmentioning

confidence: 73%

“…Some elements include the mechanism of injury, the quality of the amputated digit, storage of the amputated digit, access to care, the technical precision and quality of the surgery performed, health status of the patient, and proper post-operative care and monitoring. 19,20,31 In this study, we examined number of chronic conditions recorded for injured patients. It is plausible that presence of specific illnesses such as diabetes and not number of comorbid conditions would change the probability of success for replanted digit.…”

Section: Discussionmentioning

confidence: 99%

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Annual Hospital Volume and Success of Digital Replantation

Brown

Chung

et al. 2017

Plastic &Amp; Reconstructive Surgery

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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.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Annual Hospital Volume and Success of Digital Replantation

Brown

Chung

et al. 2017

Plastic &Amp; Reconstructive Surgery

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“…These have included the following: (1) age, (2) sex, (3) zone of injury, (4) digit number, (5) tobacco use, (6) ischemia time, (7) method of preservation, (8) use of vein graft, (9) number of venous/arterial anastomoses, and (10) mechanism of injury. 4,[6][7][8][9] With the increased quantity of published data and often conflicting results, interpreting the predictors of replant survival has become difficult. Further, few studies to date have analyzed this vast dataset systematically to draw generalized conclusions.…”

Section: Introductionmentioning

confidence: 99%

“…Previous meta-analysis studies are limited, and most focus either on distal tip amputations or on patient related variables (vs. surgery-related variables) and often include incomplete amputations. 6,7,10 Therefore, the aim of the this study was to review the current literature and conduct a quantitative statistical analysis to determine which patient-and surgery-related factors predict survival after complete digit amputation. The authors hope that this analysis will provide data to help surgeons risk-stratify replant candidates, manage patient expectations, and improve guidelines for surgical decision making.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Digit Survival following Replantation: Quantitative Review and Meta-Analysis

et al. 2018

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Microsurgical replantation following digital amputation has variable success rates. Sociodemographic factors and surgery-related variables have been shown to influence survival rates; however, few studies have evaluated these data systematically across a combined dataset. Therefore, the objective of this study was to analyze the current literature to identify the predictors of replant survival. A literature review was performed using the PubMed/Medline database focused on complete digit amputation/replantation studies. Studies were evaluated for patient and surgery-related variables and their respective effects on survival. Statistical analysis was conducted to identify predictors of survival and derive pooled estimates from the combined dataset. Thirty-two studies representing more than 6,000 digit amputation/replantation cases met inclusion/exclusion criteria. Statistical analysis revealed the number of venous anastomosis (0 vs. 1 vs. 2), the number of arterial anastomosis (0 vs. 1 vs. 2), and the mechanism of injury (sharp cut versus blunt cut versus avulsion versus crush) to influence replant survival ( < 0.05). The authors failed to find a significant association between survival and the following variables: age, sex, zone of injury, digit number, tobacco use, ischemia time, method of preservation, and use of vein graft. Patient- and surgery-related variables affect digit survival following replantation. The etiology of injury can help risk-stratify patients and assist in an informed decision making process, whereas surgery-related factors can guide surgeon practice to improve clinical outcomes following replantation.

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“…We also used acetyl salicylic acid and dextran for their anticoagulant effects (Buckley and Hammert, 2011; Levin and Cooper, 2008). Various surgeons have different preferences on the use of anticoagulants (Breahna et al, 2016; Butler et al, 2016; Ma et al, 2016; Tang et al, 2017; Wong et al, 2017).…”

Section: Discussionmentioning

confidence: 99%