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Annual Hospital Volume and Success of Digital Replantation

Brown, Matthew M.D.; Lu, Yiwen M.S.; Chung, Kevin C. M.D., M.S.; Mahmoudi, Elham Ph.D., M.S.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 672-680
doi: 10.1097/PRS.0000000000003087
Hand/Peripheral Nerve: Outcomes Article
Coding Perspective

Background: Digital replantation attempt and success rates have been declining in the United States. Regionalization of digit replantation has been proposed as a solution to improve both attempt and success rates of these procedures. There is limited information about which criteria could establish a hospital as a center specialized for digit replantation. The authors analyzed hospital replantation volume and patient factors associated with successful thumb/finger replantation.

Methods: A retrospective study using data from the 2008 to 2012 State Inpatient Databases of the Health Care Cost and Utilization Project from five states (New York, California, North Carolina, Utah, and Florida) was performed. The generalized estimating equation method was used to examine the association between patient characteristics and hospital volume and success of thumb/finger replantation. A receiver operating characteristic curve and Youden’s J statistic were used to determine annual hospital replantation volume cutoff levels for success rates.

Results: There were 3417 digit amputation injuries, with 631 replantation attempts (18 percent) and with an overall thumb/finger replantation success rate of 70 percent. The hospital annual replantation volume increased the odds of success (OR, 1.06; 95 percent CI, 1.02 to 1.10). The annual hospital volume of three replantations was needed to achieve a success rate of 70 percent.

Conclusions: Practice patterns demonstrate that hospitals with higher annual volume have greater success. Identifying high-volume centers and regionalization of digit replantation should be considered a priority.


Ann Arbor, Mich.

From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School.

Received for publication August 3, 2016; accepted September 21, 2016.

Disclosure:The authors have no commercial or financial conflicts of interest to report.

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Elham Mahmoudi, Ph.D., M.S., University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room G024W, Ann Arbor, Mich. 48202,

Copyright © 2017 by the American Society of Plastic Surgeons