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

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Health Services Research

Background:

• Traumatic digit amputations significantly impair patients' quality of life.
• Despite expert advocacy, digit replantation rates have shown a concerning decline.

Purpose of the Study:

• To investigate the national trends in the practice of digital replantation.
• To analyze factors influencing replantation attempts and success rates.

Main Methods:

• Utilized the National Inpatient Sample database (2001-2014) for adult traumatic digit amputations.
• Calculated annual rates of attempted and successful replantation, stratified by digit type and hospital type.
• Employed multivariable logistic regression to identify predictors of replantation attempt and success.

Main Results:

• Only 11.2% of 14,872 patients underwent replantation; attempt rates declined nationally for thumbs and fingers.
• Urban teaching hospitals saw increased case volume and higher replantation likelihood, but overall trends were downward.
• Replantation success rates remained stable for thumbs (82.9%) and improved for fingers (76.1% to 82.4%).
• Private insurance and higher income were associated with increased replantation likelihood; hospital type did not predict success.

Conclusions:

• The declining trend in digit replantation attempts persists despite increased treatment at urban teaching hospitals.
• Concentrating case volume in specialized hospitals is insufficient to reverse the downward trend in replantation.
• Financial considerations from both patient and surgeon perspectives are crucial for improving digit replantation care delivery.