Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, the College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Section of Plastic Surgery Department of Surgery University of Michigan Medical School, Ann Arbor, MI.
J Am Coll Surg. 2021 Jun;232(6):900-909.e1. doi: 10.1016/j.jamcollsurg.2021.03.018. Epub 2021 Apr 5.
Surgeon experience, hospital volume, and teaching hospital status may play a role in the success of digit replantation. This study aims to analyze factors that influence digit replantation success rates.
We examined patients with traumatic digit amputations, between 2000 and 2015, from the National Health Insurance Research Database (NHIRD) of Taiwan, which comprises data of more than 99% of its population. We measured the number of traumatic digit amputations and success rate of replantation. Chi-square and ANOVA tests were used for descriptive statistics. Regression models were built to analyze the association among patient, surgeon, and hospital characteristics, and replant success.
We identified 13,416 digit replantation patients using the eligibility criteria. The overall replantation failure rate was significantly higher in medium- and high-volume hospitals (low-volume: 11%, medium-volume: 17%, and high-volume: 15%, p < 0.001). Teaching hospitals had significantly higher replantation failure rates [(15.5% vs 7.6%), odds ratio (OR) 2.0; confidence interval (CI) 1.1-3.7]. Lower surgeon case volume resulted in a significantly higher failure rate in the thumb replantation (OR 0.89; CI 0.85-0.94).
Teaching hospitals had greater odds of replantation failure, owing to being high volume centers and attempting more replantations. However, the effect of residents performing the replantation during their training should be considered. Teaching units are mandatory for resident training; however, a balance should be established to provide training, but with sufficient supervision to achieve optimal replant success. A national protocol to triage digit amputation cases to high volume centers with experienced microsurgeons will help improve the replantation success rate.
外科医生经验、医院容量和教学医院地位可能在断指再植的成功中发挥作用。本研究旨在分析影响断指再植成功率的因素。
我们从台湾全民健康保险研究数据库（NHIRD）中检查了 2000 年至 2015 年期间因创伤性断指的患者，该数据库包含其超过 99%的人口的数据。我们测量了创伤性断指的数量和再植的成功率。使用卡方检验和方差分析进行描述性统计。回归模型用于分析患者、外科医生和医院特征与再植成功之间的关系。
我们使用合格标准确定了 13416 例断指再植患者。中高容量医院的整体再植失败率明显较高（低容量：11%，中容量：17%，高容量：15%，p < 0.001）。教学医院的再植失败率明显更高[（15.5%比 7.6%），优势比（OR）2.0；置信区间（CI）1.1-3.7]。较低的外科医生手术量导致拇指再植的失败率明显更高（OR 0.89；CI 0.85-0.94）。
教学医院的再植失败率更高，这是由于它们是大容量中心并尝试进行更多的再植。然而，应该考虑到住院医师在培训期间进行再植的效果。教学单位是住院医师培训的强制性要求；但是，应该建立平衡，既要提供培训，又要进行充分的监督，以实现最佳的再植成功率。将断指病例分诊到有经验的显微外科医生的高容量中心的全国方案将有助于提高再植成功率。
