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Incidence and Characterization of Major Upper-Extremity Amputations in the National Trauma Data Bank

Inkellis, Elizabeth, MD1; Low, Eric, Edison, MD, MPH2; Langhammer, Christopher, MD, PhD1; Morshed, Saam, MD, PhD1,3,a

doi: 10.2106/JBJS.OA.17.00038
Scientific Articles: PDF Only

Background: There are few recent data examining the epidemiology of severe upper-extremity trauma in non-military patients. We used the National Trauma Data Bank (NTDB) to investigate the epidemiology and descriptive characteristics of upper-extremity amputations in U.S. trauma centers.

Methods: We queried the 2009 to 2012 NTDB research datasets for patients undergoing major upper-extremity amputation and extracted characteristics of the patient population, injury distribution, and treating facilities. In addition, multivariable regression models were fit to identify correlates of reoperation, major in-hospital complications, duration of hospitalization, and in-hospital mortality.

Results: A total of 1,386 patients underwent a major upper-extremity amputation secondary to a trauma-related upper-extremity injury, representing 46 per 100,000 NTDB trauma admissions from 2009 to 2012. The most frequent definitive procedures performed were amputations through the humerus (35%), forearm (30%), and hand (14%). The average duration of hospitalization for all amputees was 17 days. Thirty-one percent of patients underwent at least 1 reoperation. The rate of reoperation was significantly higher at university-associated hospitals compared with nonteaching or community hospitals (p < 0.0001). Patients who had at least 1 reoperation stayed in the hospital approximately 7 days longer than patients who did not undergo reoperation. The Injury Severity Score, hospital teaching status, concomitant neurovascular injury, and occurrence of a complication were significantly associated with reoperation.

Conclusions: The present study provides an updated report on the epidemiology and characteristics of trauma-related major upper-extremity amputation in the U.S. civilian population. Additional work is necessary to assess the long-term outcomes following attempted upper-extremity salvage. The population-level data provided by the present study may help to inform the design and implementation of future studies on the optimum treatment for this survivable but life-altering injury.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California

2University of California, San Francisco School of Medicine, San Francisco, California

3Orthopaedic Trauma Institute, San Francisco, California

E-mail address for S. Morshed: Saam.Morshed@ucsf.edu

Investigation performed at the University of California, San Francisco, San Francisco, California

Disclosure: This work was funded partially by a resident research grant from the Orthopaedic Research and Education Fund (http://www.oref.org/). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A38).

© 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.