Chicago, Ill.; and New York, N.Y.
From the Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center; and the Hansjorg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2018 Jun;141(6):857e-867e. doi: 10.1097/PRS.0000000000004368.
Significantly fewer replantations have been performed at the authors' institution in recent years, with similar trends observed across the United States. A study of three national databases was performed to evaluate this trend, its possible cause, and national health care implications.
The National Electronic Injury Surveillance System, Bureau of Labor Statistics, and National Inpatient Sample databases were queried for cases with a diagnosis of finger amputation over available years from 2000 to 2011. Data were weighted and analyzed to give appropriate national estimates of amputations, replantations, and related clinical variables. Trend analysis was performed using modified Poisson regression.
Although workplace finger amputation rates decreased 40 percent from 2000 to 2010 (p < 0.0001), the overall finger amputation incidence did not change significantly (26,668 versus 24,215; p = 0.097). Compared with 930 replantations in 2001, only 445 were performed in 2011, more than a 50 percent decrease (p < 0.001). In all years, the majority of hospitals performing replantation performed only one (49.3 to 64.1 percent) each year, with a small minority (2.2 to 8.1 percent) performing more than 10 per year. In 2000, 120 hospitals (12.1 percent) performed at least one replantation, compared with only 80 hospitals (7.6 percent) in 2010, a 4.6 percent annual decline (p = 0.002).
There has been a striking decline in digital replantations being performed, despite a relatively stable incidence of amputations. Apparently independent of declining work-related injuries, evolving clinical decision-making may be responsible for this trend. Decreasing replantation experience among hand surgeons lends credence to the development of specialized regional centers designed to treat these complex injuries.
近年来，作者所在机构进行的再植手术明显减少，美国各地也呈现出类似的趋势。对三个国家数据库进行了一项研究，以评估这一趋势、其可能的原因以及对国家卫生保健的影响。
对 2000 年至 2011 年期间全国电子伤害监测系统、劳工统计局和全国住院患者样本数据库中诊断为手指切断的病例进行了查询。对数据进行加权和分析，以提供适当的全国范围内的截肢、再植和相关临床变量的估计值。采用修正泊松回归进行趋势分析。
尽管 2000 年至 2010 年工作场所手指截肢率下降了 40%（p<0.0001），但手指截肢的总体发生率并未显著变化（26668 例与 24215 例；p=0.097）。与 2001 年的 930 例再植术相比，2011 年仅进行了 445 例，减少了 50%以上（p<0.001）。在所有年份中，进行再植术的大多数医院每年仅进行一例（49.3%至 64.1%），少数医院（2.2%至 8.1%）每年进行超过 10 例。2000 年，有 120 家医院（12.1%）至少进行了一次再植术，而 2010 年只有 80 家医院（7.6%），每年下降 4.6%（p=0.002）。
尽管截肢的发生率相对稳定，但数字再植术的数量却大幅下降。显然与工作相关伤害的减少无关，临床决策的演变可能是造成这一趋势的原因。手部外科医生的再植经验减少，为治疗这些复杂损伤而设计的专门区域中心的发展提供了依据。
