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Proficiency and Difficulty Scoring Tools for Finger Replantation.
Kevin C Chung1, Adee Heiman2, Sunitha Malay2
1Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor.
JAMA Network Open
|October 30, 2025
Summary
Surgeon skill in digit replantation and revascularization is linked to patient outcomes. Higher surgeon proficiency scores correlate with increased success rates for these complex procedures.
Area of Science:
- Microsurgery
- Surgical Skill Assessment
- Trauma Surgery
Background:
- Replantation and revascularization are highly complex surgical procedures with variable success rates.
- Objective methods for assessing surgeon proficiency in these challenging operations are currently lacking.
- Standardized scoring systems are needed to evaluate surgeon skill and improve patient outcomes.
Purpose of the Study:
- To determine if a surgeon proficiency score is associated with clinical outcomes in digit replantation and revascularization.
- To investigate the relationship between surgeon skill, procedure difficulty, and success rates across multiple institutions.
Main Methods:
- A multicenter retrospective cohort study analyzed adult patients undergoing digit replantation or revascularization.
- Surgeon proficiency and procedure difficulty scores were calculated based on early and later procedure outcomes and patient/injury characteristics.
- Procedure success was defined as digit survival at 1 month post-operation.
Main Results:
- Overall success rate for 653 digits was 70.1%.
- Higher procedure difficulty scores were significantly associated with failed procedures (P < .001).
- Each 1-point increase in surgeon proficiency score correlated with a 7.5% increase in future success rate (P < .001).
- Adjusted analysis showed greater surgeon proficiency (OR, 1.46) and lower difficulty (OR, 0.70) were linked to higher success likelihood.
Conclusions:
- Surgeon proficiency score is a significant predictor of success in digit replantation and revascularization.
- Incorporating proficiency and difficulty scoring tools into trauma referral networks can optimize patient transfer and care.
- These findings support the need for targeted training and resource allocation to enhance surgical expertise in replant centers.
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