D99. Hand and Wrist Amputation: A Demographic Analysis Using the National Inpatient Sample

Abstract

PURPOSE: Traumatic hand and wrist amputations are rare but debilitating injuries. Surgical replantation of the hand provides a unique alternative to revision surgery but requires appropriate access to necessary medical resources. This study aims to understand how sociodemographic barriers impact the replantation rate of traumatic hand amputation on a national level. METHODS: ICD-10 codes for replantation and revision amputation surgeries were used to gather data from the National Inpatient Sample from 2016-2019. Summary statistics were calculated on demographic, hospital, and outcome variables with sub-analysis performed for effect on replantation and revision rates. RESULTS: 72 patients were identified. The average patient was 37 years old with a strong male predominance (90%). Racial distribution of the cohort roughly mirrored the demographic proportions of race in the US population. 17 (24%) patients underwent replantation. This rate was similar between sexes (p = 0.348), races (p = 0.715), and income brackets (0.620). Hand replantation was primarily performed at large bed size (87%), private not-for-profit (73%), and urban teaching hospitals (100%). The most common insurance status for these patients was private, followed by Medicaid, Medicare, then self-pay. 47 patients underwent surgical revision (65%) with no association between demographic characteristics. Patients remained hospitalized for 11 days on average, regardless of the surgery received. Patients were most frequently discharged home (65%) followed by skilled nursing facilities (18%). CONCLUSION: This study investigates the current state of hand amputation management. With this information, surgeons may be more equipped to mitigate the impact of sociodemographic characteristics on appropriate treatment.