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Ash M, Wang J, Menon A, Brown C, Ghareeb P. Time to Amputation After Traumatic Digital Injury Does Not Affect Complication Rates: A Retrospective Multi-Institutional Analysis. Hand (N Y) 2024:15589447241302360. [PMID: 39690829 DOI: 10.1177/15589447241302360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 12/19/2024]
Abstract
BACKGROUND Revisionary digital amputations are often performed after partial or full traumatic digital amputation to minimize complications while preserving as much length and functionality as possible. Many surgeons attempt revisionary procedures swiftly after initial injury. The aim of this study was to investigate the effects of time from injury to surgery on rate of complications and reoperation in revisionary traumatic digital amputations. METHODS This was a retrospective chart review of all patients undergoing revisionary digital amputation for initial traumatic amputation at a single hospital from January 1, 2007 to December 31, 2021. Demographics, comorbidities, surgical details, complications, and time from injury to surgery were collected. Five-factor modified fragility index scores were also computed for each patient. Primary outcomes of interest included complications and need for additional procedures. Secondary outcomes of interest included development of neuroma, phantom limb, and referral to a long-term pain specialist. RESULTS A total of 97 patients were identified as meeting all inclusion criteria. The average time to surgery was 14.4 days. Body mass index, comorbidities, and time to surgery were not associated with increased risk of complication. Increasing time to surgery was not significantly associated with increased risk of complications, development of neuroma, phantom limb, or a referral to long-term pain service. The only factors which were significantly associated with reoperation were absence of diabetes and hypertension. CONCLUSION Increasing time to surgery after initial injury was not significantly associated with increased risk of complications or reoperation. Surgeons should consider this when assessing urgency of surgery in patients after traumatic digital amputation.
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Affiliation(s)
- Makenna Ash
- Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer Wang
- Emory University School of Medicine, Atlanta, GA, USA
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Wang N, Xiao H, Lu H, Chen K, Zhang S, Liu F, Zhang N, Zhang H, Chen S, Xu X. Effect of PI3K/AKT/mTOR signaling pathway-based clustered nursing care combined with papaverine injection on vascular inflammation and vascular crisis after replantation of severed fingers. Mol Cell Biochem 2024; 479:1525-1534. [PMID: 37490177 PMCID: PMC11224086 DOI: 10.1007/s11010-023-04796-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/15/2023] [Accepted: 06/18/2023] [Indexed: 07/26/2023]
Abstract
This research aimed to investigate the effect of PI3K (phosphatidylinositol 3-kinase)/AKT (protein kinase B)/mTOR (mammalian target protein of rapamycin) signaling pathway-based clustering care combined with papaverine injection on vascular inflammation and vascular crisis after finger amputation and replantation. 100 patients admitted in General Hospital of Ningxia Medical University from April 2022 to December 2022 for replantation of severed fingers were selected and divided into a control group (n = 50) and an observation group (n = 50) using the randomized grouping principle. The control group received a papaverine injection and general nursing care, the observation group received a papaverine injection and clustered care. The pain score; constipation incidence; replantation finger survival rate; physician, nurse, and patient satisfaction; serum inflammatory factors; vascular crisis parameters; and occurrence of adverse reactions were compared between the two patient groups. Enzyme-linked immunosorbent assay was performed to detect PI3K, AKT, and mTOR protein concentrations in the venous blood of the two groups, and statistical analysis of the data was performed. On postoperative day 7, the pain score and incidence of constipation in the observation group were lower than those in the control group (P < 0.05); the survival rate of reimplanted fingers in the observation group was 88.00%, which was higher than that in the control group 80.00% (P < 0.05); the satisfaction of doctors, nurses, and patients in the observation group was higher than that in the control group; the concentrations of interleukin-1 (IL-1), tumor necrosis factor (TNF-α), blood flow resistance index (RI), and arterial pulsatility index (PI) in the observation group were lower than those in the control group, while the concentration of interleukin-10 (IL-10), vascular diameter, and Vm (mean blood flow velocity) were higher in the observation group than those in the control group; the differences were statistically significant (P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant (P > 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). Overall, these findings suggest that clustered care combined with papaverine injection reduces vascular inflammatory symptoms and vascular crisis in the treatment of severed finger replantation through the PI3K/AKT/mTOR signaling pathway.
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Affiliation(s)
- Na Wang
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Haijing Xiao
- Outpatient Department of the People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hongyan Lu
- Nursing Department, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, Ningxia, China.
| | - Kai Chen
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.
| | - Shuhong Zhang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fei Liu
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Zhang
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Haijing Zhang
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Siyu Chen
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaoli Xu
- Department of Stomatology, General Hospital of Ningxia Medical University, Yinchuan, China
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Dhanjani SA, Gomez G, Rogers D, LaPorte D. Are There Racial and Ethnic Disparities in Management and Outcomes of Surgically Treated Distal Radius Fractures? Hand (N Y) 2024; 19:471-480. [PMID: 36196925 PMCID: PMC11067843 DOI: 10.1177/15589447221124248] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Racial/ethnic disparities have been demonstrated across multiple orthopedic sub-specialties. There is a paucity of literature examining disparities in distal radius fracture (DRF) management. METHODS Using the National Surgical Quality Improvement Program database, we analyzed 15 559 non-Hispanic (NH) White, NH Black, NH Asian, and Hispanic adults who underwent open reduction and internal fixation for DRF from 2013 to 2019. We evaluated time from hospital admission to surgery and length of stay using Poisson regression. Deep venous thrombosis, pulmonary embolism (PE), and wound complications were reported using descriptive statistics. Thirty-day reoperation and readmission were analyzed using binary logistic regression. RESULTS Wait time to surgery was longer for Hispanic patients than NH White patients (incidence rate ratio [IRR]: 2.54, P < .001); this narrowed over time (IRR: 0.944, P = .047). Length of stay was longer for NH Black (IRR: 1.78, P < .001) and Hispanic patients (IRR: 1.83, P < .001), but shorter for NH Asian (IRR: 0.715, P = .019) than NH White patients; this temporally narrowed for NH Black patients (IRR: 0.908, P = .001). Deep venous thrombosis, PE, and wound complications occurred at a rate less than 0.30% across all groups. Hispanic patients were less likely to undergo reoperation than NH White patients (odds ratio [OR]: 0.254, P = .003). While there was no difference in readmission between groups in the aggregated study period, NH Black patients experienced a temporal increase in readmissions relative to NH White patients (OR: 1.40, P = .038). CONCLUSIONS Racial and ethnic disparities exist in DRF management. Further investigation on causes for and solutions to combat these disparities in DRF care may help improve the inequities observed.
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Affiliation(s)
| | - Gabriela Gomez
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Davis Rogers
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dawn LaPorte
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kinsey ET, Hardart A, Dabney L, Khalil S, Kaplowitz E, Brustman L. Socioeconomic factors influence surgical wait times for non-emergent gynecologic surgical procedures: a retrospective analysis. BMC Womens Health 2024; 24:115. [PMID: 38347521 PMCID: PMC10863262 DOI: 10.1186/s12905-023-02806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/30/2023] [Accepted: 11/26/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In various disciplines, an association between surgical wait times and patient outcomes has been identified. This study is among the first to investigate whether practice setting influences wait times for elective surgeries in benign gynecology. METHODS This retrospective study of patients at three New York hospitals from 10/2019-2/2020 compared surgical wait times among patients seen in federally-qualified health centers (FQHC's) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of the procedure. A multivariable mixed model was used to model surgical wait time by setting of care, adjusting for age, BMI, race, ethnicity, insurance, need for medical clearance, and scheduled block time. A univariable analysis was then utilized to assess surgical wait times by clinical setting for each insurance type. RESULTS Five hundred forty patients were identified with a median age of 45.6 years (range 16-87). Average surgical wait time was 27 days (range 1-288 days). In multivariable analysis, longer surgical wait times were associated with being seen preoperatively in a FQHC compared to the private practice setting (102% longer, 59.5 days vs. 22 days, p < 0.0001), and with needing medical clearance (56.4% longer, 45 days vs. 22 days. p = 0.0001). CONCLUSIONS These results suggest that in benign gynecology, surgical wait times are significantly influenced by the practice setting in which a patient gets care, with notable delays in care among patients who are seen in a federally qualified health center preoperatively.
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Affiliation(s)
- Elizabeth Trevino Kinsey
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, New York, NY, 10019, USA.
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of California, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | - Anne Hardart
- Division of Urogynecology, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, New York, NY, 10019, USA
| | - Lisa Dabney
- Division of Urogynecology, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, New York, NY, 10019, USA
| | - Susan Khalil
- Division of Minimally Invasive Surgery Department of Obstetrics and Gynecology, Icahn School of Medicine, 1000 10th Avenue, New York, NY, 10019, USA
| | - Elianna Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Lois Brustman
- Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 425 West 59th Street 4th Floor, New York, NY, 10019, USA
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Kohan J, Mangan J, Patel A. Access to Reconstructive Hand Surgery in the United States-Investigating the Obstacles: A Scoping Review. Hand (N Y) 2023; 18:721-731. [PMID: 36317809 PMCID: PMC10336803 DOI: 10.1177/15589447221131853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation. METHODS The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence. RESULTS Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature. CONCLUSIONS This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.
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Affiliation(s)
- Joshua Kohan
- The University of Vermont Robert Larner College of Medicine, Burlington, USA
| | - Jack Mangan
- The University of Vermont Robert Larner College of Medicine, Burlington, USA
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Henry R, Liasidis PK, Olson B, Clark D, Gomez TH, Ghafil C, Ding L, Matsushima K, Schreiber M, Inaba K. Disparities in Care Among Gunshot Victims: A Nationwide Analysis. J Surg Res 2023; 283:59-69. [PMID: 36372028 DOI: 10.1016/j.jss.2022.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/15/2022] [Revised: 06/30/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Given the well-known healthcare disparities most pronounced in racial and ethnic minorities, trauma healthcare in underrepresented patients should be examined, as in-hospital bias may influence the care rendered to patients. This study seeks to examine racial differences in outcomes and resource utilization among victims of gunshot wounds in the United States. METHODS This is a retrospective review of the National Trauma Data Bank (NTDB) conducted from 2007 to 2017. The NTDB was queried for patients who suffered a gunshot wound not related to accidental injury or suicide. Patients were stratified according to race. The primary outcome for this study was mortality. Secondary outcomes included racial differences in resource utilization including air transport and discharge to rehabilitation centers. Univariate and multivariate analyses were used to compare differences in outcomes between the groups. RESULTS A total of 250,675 patients were included in the analysis. After regression analysis, Black patients were noted to have greater odds of death compared to White patients (odds ratio [OR] 1.14, confidence interval [CI] 1.037-1.244; P = 0.006) and decreased odds of admission to the intensive care unit (ICU) (OR 0.76, CI 0.732-0.794; P < 0.001). Hispanic patients were significantly less likely to be discharged to rehabilitation centers (Hispanic: 0.78, CI 0.715-0.856; P < 0.001). Black patients had the shortest time to death (median time in minutes: White 49 interquartile range [IQR] [9-437] versus Black 24 IQR [7-205] versus Hispanic 39 IQR [8-379] versus Asian 60 [9-753], P < 0.001). CONCLUSIONS As society carefully examines major institutions for implicit bias, healthcare should not be exempt. Greater mortality among Black patients, along with differences in other important outcome measures, demonstrate disparities that encourage further analysis of causes and solutions to these issues.
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Affiliation(s)
- Reynold Henry
- Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon.
| | - Panagiotis K Liasidis
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California
| | - Blade Olson
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California
| | - Damon Clark
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California
| | - Tatiana Hoyos Gomez
- Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Cameron Ghafil
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California
| | - Li Ding
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California
| | - Martin Schreiber
- Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, California
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Do racial disparities exist at various time points during an emergency department visit for chest pain. Am J Emerg Med 2022; 58:1-4. [DOI: 10.1016/j.ajem.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 12/24/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022] Open
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Kobo-Greenhut A, Holzman K, Raviv O, Arad J, Ben Shlomo I. Applying health-six-sigma principles helps reducing the variability of length of stay in the emergency department. Int J Qual Health Care 2021; 33:6278246. [PMID: 34009361 DOI: 10.1093/intqhc/mzab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/30/2020] [Revised: 03/20/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Reducing length of stay (LOS) is one of the urgent problems in healthcare systems worldwide. Popular methods that are used to reduce LOS are the Lean and the 6 Sigma, which in practice result in limited improvements. In this paper, we introduce and test a tailored method for implementing the 6 Sigma principles in healthcare (we call H-6S). OBJECTIVE To reduce the variability in the time between admission and discharge of patients in the emergency department. METHODS The study took place within the emergency department (ED) of Josephtal Medical Center in Eilat, Israel. Our analysis focused on the processes of examining and treating patients from admission to ED until discharge home. The analysis was done during the second quarter of 2018. The implementation of the recommendations took place during Q3 2018. The reported results are from Q3 2018 to Q2 2019, compared to the corresponding period in 2017 (experienced team). RESULTS In Q2 2017, LOS was 2.42 ± 2.07 h (experienced team, n = 9928). In Q2 2018, the LOS was 2.62 ± 7.04 h (before the H-6S, inexperienced team, n = 9484). In Q2 2019 following the intervention, it reached 2.3 ± 1.74 h (n = 7647). The differences between the standard deviations of the three periods are significant. CONCLUSION Implementing H-6S dropped the variance of LOS within 3 months and remained low for the whole year. Each new team of physicians who enter the ED should be thoroughly instructed as to the routines and expectations of the system from them, which should narrow the differences of previous education between them.
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Affiliation(s)
| | | | - Osnat Raviv
- Department of Emergency Department, Yoseftal Medical Center, Eilat, Israel
| | - Jakov Arad
- Department of Emergency Department, Yoseftal Medical Center, Eilat, Israel
| | - Izhar Ben Shlomo
- Zefat Academic College, Safed, Israel.,Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel
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Endo RR, Fernandes CH, Fernandes M, Santos JBGD, Angelini LC, Nakachima LR. The Role of the Hand Surgeon in Microsurgery in Brazil. Rev Bras Ortop 2019; 54:309-315. [PMID: 31363286 PMCID: PMC6597419 DOI: 10.1055/s-0039-1692433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/21/2018] [Accepted: 07/02/2018] [Indexed: 11/25/2022] Open
Abstract
Objective
This study evaluates the conditions for microvascular procedures found by hand surgeons in Brazilian clinical practices.
Methodology
A prospective, observational, and analytical primary clinical research conducted during the 37
th
Brazilian Congress of Hand Surgery, from March 30
th
to April 1
st
, 2017, in Belo Horizonte, in which physicians answered 12 closed, objective, multiple-choice questions regarding their geographic region, type of institution (public or private), microsurgical training, time of experience, technical conditions, the availability of a standby team for emergencies and compensation.
Results
The study analyzed 143 hand surgeons; among them, 65.7% participants were based at the Southeast region, 13.3% in the Northeast region, 11.9% in the South region, 6.3% in the Central-West region and 2.8% in the North region. Regarding the time of experience, 43.4% of the hand surgeons had less than 5 years, 16.8% had 5 to 10 years, 23.8% 10 to 20 years, and 23% had more than 20 years of practice in microvascular surgery. Seven percent of the surgeons had no training in microvascular surgery; for 63.6%, training occurred during medical residency, whereas 30.8% were trained in another institution, and 7.7% in another country. Among these surgeons, 76.9% worked at both private and public hospitals, 14.7% at private hospitals and 5.6% at public hospitals. Regarding compensation, 1.8% of the surgeons considered it adequate, and 98.2%, inadequate in public hospitals, whereas 5.0% considered it adequate, and 95.0%, inadequate in private hospitals.
Conclusion
This research shows that most surgeons were trained in microsurgery, had never performed reattachments, and considered that compensation is inadequate; moreover, standby teams were not available. There are few, unevenly distributed hand surgeons with microsurgical ability in emergency settings, and their compensation is low.
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Affiliation(s)
- Rosana Raquel Endo
- Serviço de Cirurgia de Mão e Microcirurgia, Hospital do Servidor Público Municipal, São Paulo, SP, Brasil
| | - Carlos Henrique Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Instituto de Cirurgia da Mão, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Marcela Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Instituto de Cirurgia da Mão, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Joao Baptista Gomes Dos Santos
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Instituto de Cirurgia da Mão, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Luiz Carlos Angelini
- Disciplina de Anatomia da Ortopedia, Universidade Metropolitana de Santos, Santos, SP, Brasil
| | - Luis Renato Nakachima
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Instituto de Cirurgia da Mão, Universidade Federal de São Paulo, São Paulo, Brasil
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Regional Variation and Trends in the Timing of Lower Extremity Reconstruction: A 10-Year Review of the Nationwide Inpatient Sample. Plast Reconstr Surg 2019; 142:1337-1347. [PMID: 30511989 DOI: 10.1097/prs.0000000000004885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ideal timing of soft-tissue coverage for open lower extremity fractures remains controversial. Using U.S. national data, this study aims to characterize secular trends and regional variation in the timing of soft-tissue coverage. METHODS Using discharge data from the Nationwide Inpatient Sample (2002 to 2011), the authors identified 888 encounters admitted from the emergency department with isolated open lower extremity fractures treated with pedicled or free tissue transfer. Soft-tissue coverage timing was assessed by patient factors, hospital characteristics, and fracture patterns. Statistical significance and secular trends were analyzed with generalized linear models. RESULTS The mean day of soft-tissue reconstruction was at 6.64 days. Over the 10-year period, the day of reconstruction increased significantly (from 6.12 days in 2002 to 12.50 days in 2011; coefficient, 0.09; 95 percent CI, 0.05 to 0.12; p < 0.001). Demographic and facility factors did not significantly impact timing. Elixhauser comorbidity scores greater than 2 were associated with later coverage (10.13 days versus 6.29 days; p = 0.001) along with multisite fractures (8.35 days; p = 0.022) and external fixators (8.78 days; p < 0.001). The U.S. Census division showed significant variation in timing ranging from 0.94 days (East North Central) to 9.84 days (Pacific). CONCLUSIONS A progressive delay in the timing of soft-tissue reconstruction was noted and may be attributed to negative-pressure wound therapy. The timing of soft-tissue coverage varied by region after adjusting for patient and hospital factors. Additional studies are needed to understand the impact of delayed soft-tissue coverage on patient outcomes and health services utilization.
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Cho HE, Zhong L, Kotsis SV, Chung KC. Finger Replantation Optimization Study (FRONT): Update on National Trends. J Hand Surg Am 2018; 43:903-912.e1. [PMID: 30286850 PMCID: PMC6176738 DOI: 10.1016/j.jhsa.2018.07.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 05/31/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Traumatic digit amputations have an adverse impact on patients' daily living. Despite experts advocating for digit replantation, studies have shown a continued decrease in rate of replantation. We performed a national-level investigation to examine the recent trend of practice for digital replantation. METHODS We used the National Inpatient Sample database under the Healthcare Cost and Utilization Project to select adult patients with traumatic digit amputation from 2001 to 2014. We calculated the rate of attempted and rate of successful digit replantation per year, subcategorizing for digit type (thumb or finger) and for hospital type (rural, urban nonteaching, or urban teaching). We also analyzed the pattern of distribution of case volume to each hospital type per year. We used 2 multivariable logistic regression models to investigate patient demographic and hospital characteristics associated with the odds of replantation attempt and success. RESULTS Among the 14,872 adult patients with a single digit amputation from 2001 to 2014, only 1,670 (11.2%) underwent replantation. The rate of replantation attempt trended down over the years for both thumb and finger injuries at all hospital types, despite increasing proportions of cases being sent to urban teaching hospitals where they were more than twice as likely to undergo replantation. The rate of successful replantation stayed stable for the thumb at 82.9% and increased for fingers from 76.1% to 82.4% over the years. Patients were more likely to undergo replantation if they had private insurance or a higher level of income. Neither hospital case volume nor hospital type was predictive of successful replantation. CONCLUSIONS Although more single-digit amputations were treated by urban teaching hospitals with higher likelihood to replant, the downward trend in rate of attempt regardless of hospital type demonstrates that concentration of case volume is not the solution to reverse the declining trend. CLINICAL RELEVANCE Financial aspects of digit replantation need to be considered from both the patients' and the surgeons' perspectives to improve delivery of care for digit replantation.
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Affiliation(s)
- Hoyune E Cho
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Lin Zhong
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Sandra V Kotsis
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI.
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Thayer MK, Bellevue KD, Friedrich JB. Current concepts in hand and upper extremity amputations. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/25/2022]
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