Hustedt Joshua W, Bohl Daniel D, Champagne Lloyd
Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.
Department of Orthopedics, Rush University Medical Center, Chicago, IL.
J Hand Surg Am. 2016 May;41(5):593-601. doi: 10.1016/j.jhsa.2016.02.011. Epub 2016 Mar 22.
Recent reports suggest a decrease in success rates in digital replantation in the United States. We hypothesize that this decrease may be associated with decentralization of replants away from high-volume hospitals.
All amputation injuries and digital replants captured by the National Inpatient Sample during 1998 to 2012 were identified. Procedures were characterized as occurring at high-volume hospitals (> 20 replants/y), and as being performed by high-volume surgeons (> 5 replants/y). A successful procedure was defined as one in which a replantation occurred without a subsequent revision amputation. Hospital and surgeon volume were tested for association with the year and the success of the procedure.
The authors identified 101,693 amputation injuries resulting in 15,822 replants. The overall success of replants dropped from 74.5% during 2004 to 2006 to 65.7% during 2010 to 2012. The percentage of replants being performed at high-volume hospitals decreased from 15.5% during 2004 to 2006 to 8.9% during 2007 to 2009. Similarly, the percentage of replants being performed by high-volume surgeons decreased from 14.4% during 1998 to 2000 to 2.6% during 2007 to 2009. Replants performed by high-volume surgeons operating at high-volume hospitals had higher success rates than low-volume surgeons operating at low-volume hospitals (92.0% vs 72.1%). In addition, high-volume surgeons operating at high-volume hospitals attempted replantation at greater rates than low-volume surgeons operating at low-volume hospitals (21.5% vs 11.0%). Overall, an amputation injury presenting to a high-volume surgeon at a high-volume center had a 2.5 times greater likelihood of obtaining a successful replantation than an amputation injury presenting to a low-volume surgeon at a low-volume hospital.
These data suggest that decreased success rates of digital replantation in the United States are correlated with the decentralization of digital replantation away from high-volume hospitals.
The establishment of regional centers for replant referral may greatly increase the success of digital replantation in the United States.
近期报告显示美国断指再植成功率有所下降。我们推测这种下降可能与再植手术从高手术量医院向其他医院分散有关。
确定1998年至2012年期间美国国家住院病人样本数据库中记录的所有截肢损伤及断指再植病例。手术被分为在高手术量医院（每年>20例再植手术）进行，以及由高手术量外科医生（每年>5例再植手术）实施。成功的手术定义为再植后未进行二期截肢的手术。对医院和医生的手术量与年份以及手术成功率之间的关联进行检验。
作者共识别出101,693例截肢损伤病例，其中有15,822例进行了断指再植。再植手术的总体成功率从2004年至2006年期间的74.5%降至2010年至2012年期间的65.7%。在高手术量医院进行再植手术的比例从2004年至2006年期间的15.5%降至2007年至2009年期间的8.9%。同样，由高手术量外科医生实施再植手术的比例从1998年至2000年期间的14.4%降至2007年至2009年期间的2.6%。在高手术量医院由高手术量外科医生进行的再植手术成功率高于在低手术量医院由低手术量外科医生进行的再植手术成功率（92.0%对72.1%）。此外，在高手术量医院的高手术量外科医生尝试进行再植手术的比例高于在低手术量医院的低手术量外科医生（21.5%对11.0%）。总体而言，在高手术量中心由高手术量外科医生处理的截肢损伤获得成功再植的可能性比在低手术量医院由低手术量外科医生处理的截肢损伤高2.5倍。
这些数据表明美国断指再植成功率的下降与断指再植手术从高手术量医院向其他医院分散有关。
建立区域性断指再植转诊中心可能会大大提高美国断指再植的成功率。
