Oakland University William Beaumont School of Medicine, Rochester, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
J Hand Surg Am. 2021 Nov;46(11):952-962.e24. doi: 10.1016/j.jhsa.2021.06.017. Epub 2021 Aug 6.
The rates of upper extremity reconstruction for patients with tetraplegia remain low. We performed a retrospective study to assess recent reconstruction rates and delineate factors associated with the occurrence of reconstruction.
We examined the National Inpatient Sample database (2012-2017) for the rate of reconstruction for patients with tetraplegia. The details of provider distribution characteristics and neighborhood attributes were obtained from the American Medical Association Physician Masterfile and based on the area deprivation index, respectively. We calculated the mean reconstruction rate per year and generated multivariable logistic regression models to examine the influence of patient factors, hospital characteristics, and provider distribution on the odds of undergoing functional reconstruction for tetraplegia patients.
Among 404,660 encounters with patients with tetraplegia, only 1,430 (0.4%) patients underwent upper extremity reconstruction from 2012 to 2017, with a mean rate of 238 procedures per year. We identified 5,450 hand surgeons, 12,751 physiatrists, and 444 spinal cord injury specialists, with variation in their national distribution. A greater number of surgeons near SCIS was associated with increased probability of reconstruction (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.12). The odds of surgery were greater for patients receiving care at urban teaching (OR 5.00, 95% CI 3.35-7.47) or urban nonteaching (OR 1.71, 95% CI 1.11-2.63) hospitals, whereas those at private nonprofit (OR 0.67, 95% CI 0.58-0.78) or investor-owned (OR 0.65, 95% CI 0.52-0.82) hospitals had lower odds. Although most patients had insurance coverage, patients with a higher income or those who received subsidized care had greater odds of undergoing reconstruction.
Reconstruction rates remain low and are correlated with the environment of care, financial factors, and provider availability. Policies that focus on reducing these factors in addition to increasing interspecialty collaboration could improve access to surgery for patients with tetraplegia.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic I.
四肢瘫痪患者的上肢重建率仍然较低。我们进行了一项回顾性研究，以评估最近的重建率，并描述与重建发生相关的因素。
我们检查了 2012 年至 2017 年国家住院患者样本数据库中四肢瘫痪患者的重建率。提供者分布特征和邻里属性的详细信息分别从美国医学协会医师主文件和基于区域剥夺指数获得。我们计算了每年的平均重建率，并生成了多变量逻辑回归模型，以检查患者因素、医院特征和提供者分布对四肢瘫痪患者接受功能重建的可能性的影响。
在 404660 例四肢瘫痪患者的就诊中，2012 年至 2017 年仅 1430 例（0.4%）患者接受了上肢重建，平均每年进行 238 次手术。我们确定了 5450 名手外科医生、12751 名物理治疗师和 444 名脊髓损伤专家，他们在全国的分布情况存在差异。靠近脊髓损伤中心的外科医生数量较多与重建概率增加相关（优势比 [OR] 1.07，95%置信区间 [CI] 1.03-1.12）。在城市教学（OR 5.00，95%CI 3.35-7.47）或城市非教学（OR 1.71，95%CI 1.11-2.63）医院接受治疗的患者手术可能性更大，而在私立非营利（OR 0.67，95%CI 0.58-0.78）或投资者所有（OR 0.65，95%CI 0.52-0.82）医院接受治疗的患者手术可能性较小。尽管大多数患者都有保险，但收入较高或接受补贴的患者接受重建的可能性更大。
重建率仍然较低，与护理环境、财务因素和提供者可用性相关。除了增加专科间合作外，专注于减少这些因素的政策可能会改善四肢瘫痪患者的手术机会。
研究类型/证据水平：预后 I 级。
