Preoperative Deficiency Anemia in Digital Replantation: A Marker of Disparities, Increased Length of Stay, and Hospital Cost

Abstract

Introduction The effects of preoperative anemia have been shown to be an independent risk factor associated with poor outcomes in both cardiac and noncardiac surgery. Socioeconomic status and race have also been linked to poor outcomes in a variety of conditions. This study was designed to study iron deficiency anemia as a marker of health disparities, length of stay and hospital cost in digital replantation. Materials and Methods Digit replantations performed between 2008 and 2014 were reviewed from the National Inpatient Sample (NIS) database using the ICD-9-CM procedure codes 84.21 and 84.22. Patients with more than one code or with an upper arm (83.24) or hand replantation (84.23) code were excluded. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Digit replantations were separated into patients with and without deficiency anemia. Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and t-tests. Multivariate regressions were utilized to assess the effects of anemia on total cost and length of stay. The regression controlled for demographics, region, income, insurance, hospital type, and comorbidities. Beta coefficient was calculated for length of stay and hospital cost. The regression controlled for significant age, race, region, and comorbidities in addition to the above variables. Results In the studied patient population of those without anemia, 59.5% were Caucasian, and in patients with anemia, 46.7% were Caucasian (p < 0.001). Whereas in the in the studied patient population of those without anemia, 6.7% were Black, and in patients with anemia, 15.7% were Black (p < 0.001). Median household income, payer information, length of stay and total cost of hospitalization had statistically significant differences. Using regression and β-coefficient, the effect of anemia on length of stay and cost was also significant (p < 0.001). Regression controlled for age, race, region and comorbidities, with the β-coefficient for effect on cost 37327.18 and on length of stay 3.96. Conclusion These data show that deficiency anemias are associated with a significant increase in length and total cost of stay in patients undergoing digital replantation. Additionally, a larger percentage of patients undergoing digital replantations and who have deficiency anemia belong to the lowest income quartile. Our findings present an important finding for public health prevention and resource allocation. Future studies could focus on clinical intervention with iron supplementation at the time of digital replantation.

Neural interactions in the human frontal cortex dissociate reward and punishment learning

“…One of the contacts located in the white matter was used as a reference. Anatomical localizations of iEEG contacts were determined based on post-implant computed tomography scans or post-implant MRI scans coregistered with pre-implantation scans ( Lachaux et al, 2003 ; Chouairi et al, 2022 ). All patients gave written informed consent and the study received approval from the ethics committee (CPP 09-CHUG-12, study 0907) and from a competent authority (ANSM no: 2009-A00239-48).…”

“…Bipolar derivations were computed between adjacent electrode contacts to diminish contributions of distant electric sources through volume conduction, reduce artifacts, and increase the spatial specificity of the neural data. Bipolar iEEG signals can approximately be considered as originating from a cortical volume centered within two contacts ( Brovelli et al, 2005 ; Bastin et al, 2016 ; Combrisson et al, 2017 ), thus providing a spatial resolution of approximately 1.5–3 mm ( Lachaux et al, 2003 ; Jerbi et al, 2009 ; Chouairi et al, 2022 ). Recording sites with artifacts and pathological activity (e.g.…”