National Population Study of the Effect of Structure and Process on Outcomes of Digit Replantation - 21/05/21
Abstract |
Background |
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.
Study design |
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.
Results |
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).
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Abbreviations and Acronyms : NHI, NHIRD, OR
Plan
| Disclosure Information: Nothing to disclose. |
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| Disclosures outside the scope of this work: Dr Chung receives book royalty payments from Wolters Kluwer and Elsevier and receives travel payments for conferences from Axogen. Other authors have nothing to disclose. |
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| Support: Research reported in this publication was supported by grant funding from Chang Gung Memorial Hospital, number [CORPG3G0141], and Maintenance Project of the Center for Artificial Intelligence in Medicine, grant [CLRPG3H0012]. Dr Chung's institute is supported by Chang Gung Memorial Hospital grant [P50 Ar070600], NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases grants [U01 AR073845, T32GM008616], and American Foundation for Surgery of the Hand grants. |
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| Disclaimers: Chang Gung Memorial Hospital provided statistical consultation and support for the research reported in the project. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sponsor. |
Vol 232 - N° 6
P. 900 - juin 2021 Retour au numéro
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