Valentine Lauren, Weidman Allan A, Foppiani Jose, Hernandez Alvarez Angelica, Kim Erin, Hassell Natalie E, Elmer Nicholas, Engmann Toni F, Lin Samuel J, Dowlatshahi Sammy
From the Division of Plastic Surgery.
Division of Trauma Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center.
Plast Reconstr Surg. 2025 Mar 1;155(3):566-573. doi: 10.1097/PRS.0000000000011439. Epub 2024 Mar 29.
Postamputation pain is a debilitating sequela of upper extremity (UE) amputation. Targeted muscle reinnervation (TMR) is a relatively novel treatment that can help prevent pain and improve quality of life. The purpose of this study was to evaluate national trends in the application of immediate TMR following UE amputations.
An analysis of the Nationwide Inpatient Sample database was conducted from 2016 to 2019. International Classification of Diseases, 10th Revision, codes were used to identify encounters involving UE amputation with and without TMR. Nationwide Inpatient Sample weights were used to estimate national estimates of incidence. Patient-specific and hospital-specific factors were analyzed to assess associations with use of TMR.
A total of 8945 weighted encounters underwent UE amputation, and of those, only 310 (3.5%) received TMR. The majority of TMR occurred in urban hospitals (>95%). Younger patients (47 years versus 54 years; P = 0.008) and patients located in New England were significantly more likely to undergo TMR. There was no difference in total cost of hospitalization among patients who underwent TMR ($55,241.0 versus $59,027.8; P = 0.683) but significantly shorter lengths of hospital stay when undergoing TMR versus other management (10.6 days versus 14.8 days; P = 0.012).
TMR has purported benefits of pain reduction, neuroma prevention, and increased prosthetic control. Access to this beneficial procedure following UE amputation varies by demographics and geographic region. Given that TMR has not been shown to increase cost while simultaneously decreasing patient length of stay, increased efforts to incorporate this procedure into training and practice will help to ensure equitable care for amputation patients.
截肢后疼痛是上肢截肢令人衰弱的后遗症。靶向肌肉再支配术（TMR）是一种相对新颖的治疗方法，有助于预防疼痛并改善生活质量。本研究的目的是评估上肢截肢后立即应用TMR的全国趋势。
对2016年至2019年的全国住院患者样本数据库进行分析。使用国际疾病分类第十版编码来识别涉及有或无TMR的上肢截肢病例。全国住院患者样本权重用于估计全国发病率。分析患者特定和医院特定因素，以评估与TMR使用的相关性。
共有8945例加权上肢截肢病例，其中只有310例（3.5%）接受了TMR。大多数TMR发生在城市医院（>95%）。年轻患者（47岁对54岁；P = 0.008）和新英格兰地区的患者接受TMR的可能性显著更高。接受TMR的患者住院总费用与未接受TMR的患者相比无差异（55241.0美元对59027.8美元；P = 0.683），但与其他治疗相比，接受TMR时住院时间显著缩短（10.6天对14.8天；P = 0.012）。
TMR据称具有减轻疼痛、预防神经瘤和增强假肢控制的益处。上肢截肢后获得这种有益手术的机会因人口统计学和地理区域而异。鉴于TMR未显示会增加成本，同时能缩短患者住院时间，加大力度将该手术纳入培训和实践将有助于确保为截肢患者提供公平的护理。
