Mahmoudi Elham, Huetteman Helen E, Chung Kevin C
Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI.
Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI.
J Hand Surg Am. 2017 Jan;42(1):25-33.e6. doi: 10.1016/j.jhsa.2016.10.016.
The recommended surgical treatment after thumb amputation is replantation. In the United States, fewer than 40% of thumb amputation injuries are replanted, and little is known about factors associated with the probability of replantation. We aimed to investigate recent trends and examine patient and hospital characteristics that are associated with increased probability of attempted thumb replantation. We hypothesized that higher-volume teaching hospitals and level-I trauma centers attempted more replantations.
We used 2007-2012 data from the National Trauma Data Bank. Our final sample included 2,206 traumatic thumb amputation patients treated in 1 of 365 centers during the study period. First, we used a 2-level hierarchical logistic model to estimate the odds of replantation. In addition, we used a treatment effect estimation method, with the inverse propensity score weighting to examine the difference in thumb replantation if the only variation among patients was their presumptive payer.
There was a higher probability of attempted replantation at teaching hospitals than nonteaching hospitals (odds ratio [OR], 1.40). Patients were less likely to undergo replantation at a level II (OR, 0.53) or a level III (OR, 0.33) trauma center. The uninsured were less likely to undergo replantation (OR, 0.61) than those with private insurance.
Having insurance coverage and being treated in a high-volume, teaching, level-I trauma hospital increased the odds of replantation after traumatic thumb amputation. Regionalization may lead to a higher number of indicated cases of replantation actually being attempted.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
拇指离断术后推荐的手术治疗方法是再植术。在美国，拇指离断伤接受再植术的比例不到40%，且对于与再植可能性相关的因素知之甚少。我们旨在调查近期趋势，并研究与拇指再植尝试可能性增加相关的患者和医院特征。我们假设高容量教学医院和一级创伤中心进行的再植术更多。
我们使用了国家创伤数据库2007 - 2012年的数据。我们的最终样本包括在研究期间于365个中心之一接受治疗的2206例创伤性拇指离断患者。首先，我们使用二级分层逻辑模型来估计再植的几率。此外，我们使用了一种治疗效果估计方法，即逆倾向评分加权法，以研究如果患者之间唯一的差异是其推定支付方，拇指再植的差异情况。
教学医院进行再植尝试的可能性高于非教学医院（优势比[OR]，1.40）。患者在二级（OR，0.53）或三级（OR，0.33）创伤中心接受再植术的可能性较小。未参保患者接受再植术的可能性（OR，0.61）低于有私人保险的患者。
有保险覆盖且在高容量、教学型一级创伤医院接受治疗，可增加创伤性拇指离断术后再植的几率。区域化可能会导致更多实际尝试再植的指征性病例。
研究类型/证据水平：治疗性II级。
