Monir Joseph G, Cooke Hayden, Jagiella-Lodise Olivia, McQuillan Thomas, Wagner Eric, Zelenski Nicole A
Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA.
J Hand Surg Glob Online. 2024 Aug 29;6(6):855-860. doi: 10.1016/j.jhsg.2024.07.012. eCollection 2024 Nov.
Digit amputations can be managed either with replantation or revision amputation. The advent and refinement of microsurgical techniques allowed for the reliable success of replantation. Despite this, rates of digit replantation have been decreasing over the past several decades. A paucity of data exists on recent trends. The authors hypothesize that rates of both replantation and revision amputation will continue to downtrend.
IBM Watson Health Marketscan Commercial Claims and Encounters and Medicare Supplemental databases were queried for digit replantation and revision amputations from 2009 to 2019. National volumes and incidences were estimated by combining these data with population data from the United States Census Bureau Public Use Microdata Sample. Linear regression was performed to evaluate trends. Subgroup analysis was performed for both volume and incidence to elucidate the role of age, sex, and geographical location.
Between 2009 and 2019, there were an estimated 2,207 digit replantations and 53,810 digit revision amputations. The volume of replantations decreased by 42.2%, and the incidence of replantations decreased by 46.3%. The volume of revision amputations decreased by 16.2%, and the incidence of revision amputations decreased by 22.2%. Men were the majority of both groups, accounting for 75.6% of replantations and 83.6% of amputations. The replantation-to-amputation ratio decreased from 0.057 to 0.039 (-31.0%).
Both digit replantations and revision amputations continued to decline over the decade from 2009 to 2019. The downtrend in replantations outpaced the downtrend in revision amputations, resulting in a decreased replantation-to-amputation ratio.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
手指截肢可采用再植或修正性截肢进行处理。显微外科技术的出现和完善使得再植手术能够可靠地取得成功。尽管如此，在过去几十年中，手指再植的比例一直在下降。关于近期趋势的数据很少。作者推测，再植和修正性截肢的比例都将继续呈下降趋势。
查询了IBM Watson Health Marketscan商业理赔与病历数据库以及医疗保险补充数据库，以获取2009年至2019年期间手指再植和修正性截肢的数据。通过将这些数据与美国人口普查局公共使用微观数据样本中的人口数据相结合，估算了全国的手术量和发病率。进行线性回归以评估趋势。对手术量和发病率进行亚组分析，以阐明年龄、性别和地理位置的作用。
2009年至2019年期间，估计有2207例手指再植和53810例手指修正性截肢。再植手术量下降了42.2%，再植发病率下降了46.3%。修正性截肢手术量下降了16.2%，修正性截肢发病率下降了22.2%。两组中男性均占多数，再植手术中男性占75.6%，截肢手术中男性占83.6%。再植与截肢的比例从0.057降至0.039（-31.0%）。
从2009年到2019年的十年间，手指再植和修正性截肢的比例均持续下降。再植比例的下降速度超过了修正性截肢比例的下降速度，导致再植与截肢的比例降低。
研究类型/证据水平：治疗性IV级。
