D10. The True Story Behind Isolated Hand or Digit Traumatic Amputations: A One-year Evaluation of Traumatic Amputation Treatment Course and Success of Replantation

Abstract

PURPOSE: The post-discharge longitudinal care following isolated hand or digit traumatic amputation (IHDTA) has yet to be described nationally. We assessed replantation rates and factors associated with optimal management following hand or digit amputation nationwide. METHODS: Adult patients who sustained IHDTA were identified in the Nationwide Readmission Database (2010-2019) and followed-up for 6 months. Patients were stratified according to management (replantation attempt, surgical amputation). Replantation attempt and failure (surgical amputation following replant), and measures of healthcare utilization were assessed using regression modeling controlling for patient-and hospital-level factors. RESULTS: 16,856 patients were identified. Of these 2,319 (13.8%) underwent replantation, 8,152 (48.4%) underwent surgical amputation, and 6,384 (37.9%) received no surgical treatment on initial presentation. There was a significant decrease in the proportion replantation attempts between 2010-2019 (p<0.05). Successful replantation at index admission was 67.2% with continued viability of 97.9% 6-months after initial discharge. There was no difference in unplanned readmission between patients who underwent replantation vs. surgical amputation though replanted patients had longer length of stay, costs, and complications (all p>0.05). Factors associated with replantation were higher socioeconomic status, admission to high-volume, and private not-for profit hospital (all p<0.05). CONCLUSION: Replantation occurs only in a small proportion of patients with IHDTA, and there is a national downtrend in replantation attempts. A small proportion of patients will go onto revision amputation once they have been discharged with viable replanted digits/hand. Efforts to enhance hand trauma care networks are warranted as patients treated at high-volume centers are more likely to undergo replant.