Finger Replantation Optimization Study (FRONT): Update on National Trends

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There is no financial information to disclose. We performed a national-level investigation of patients with traumatic digit amputation to examine (1) the recent trend in digital replantation surgery and (2) the influence of patient and hospital characteristics over 14 years between 2001 and 2014. We hypothesized that despite efforts toward regionalization to improve outcomes, the rate of attempt and successful digit replantation has continued to decrease. We used the National Inpatient Sample database under the Healthcare Cost and Utilization Project to select adult patients with a diagnosis of traumatic digit amputation. We calculated the rates of attempted and successful digit replantation per year, subcategorizing for digit type (thumb or finger) and for hospital type (rural, urban non-teaching, and urban teaching) to determine the trend of practice. We also analyzed for case volume distribution to each hospital type each year. We used a multivariable logistic regression model to investigate patient demographic and hospital characteristics associated with the odds of successful revascularization. Among the 14,872 adult patients with single-digit amputation from 2001 to 2014, only 1,670 (11.2%) underwent replantation. The rates of replantation attempt trended down over the years for both thumb (slope –0.4) and fingers (slope –0.2) at all hospital types (Figure 85-1AB) despite increasing proportions of patients being sent to urban teaching hospitals (56.9% to 81.2%) (Figure 85-2) where they were more likely to undergo replantation (odds ratio 2.4, P = 0.05). •The rate of digit replantation decreased over 14 years for both thumb and fingers, regardless of hospital type, while the rate of success remained relatively stable.•Although more digit amputations are treated by urban teaching hospitals with higher likelihood to replant, the downward trend in rate of attempt demonstrates a need for a paradigm shift in current pattern of practice.•Health care reforms and effective policy making are imperative to support regionalization of digit replantation to streamline the delivery of care and improve resource utilization, in line with the efforts by the American Society for Surgery of the Hand and the American College of Surgeons.Figure 85-2Case Distribution per Hospital Type (2001–2014).View Large Image Figure ViewerDownload Hi-res image Download (PPT)