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J Hand Microsurg 2023; 15(01): 018-022
DOI: 10.1055/s-0040-1719230
Original Article

Effect of Hospital Characteristics on Performance of Pediatric Digit Replantation in the United States

Neill Y. Li 
1   Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
,
Justin E. Kleiner
2   Department of Orthopaedics, Boston University School of Medicine, Boston, Massachusetts, United States
,
Edward J. Testa
1   Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
,
Nicholas J. Lemme
1   Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
,
Avi D. Goodman
1   Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
,
Julie A. Katarincic
1   Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
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Abstract

Introduction Utilize a national pediatric database to assess whether hospital characteristics such as location, teaching status, ownership, or size impact the performance of pediatric digit replantation following traumatic digit amputation in the United States.

Materials and Methods The Kid's Inpatient Database (KID) was used to query pediatric traumatic digit amputations between 2000 and 2012. Ownership (private and public), teaching status (teaching and non-teaching), location (urban and rural), hospital type (general and children's), and size (large and small-medium) characteristics were evaluated. Replantations were then divided into those that required subsequent revision replantation or amputation. Fisher's exact tests and multivariable logistic regressions were performed with p <0.05 considered statistically significant.

Results Overall, 1,015 pediatric patients were included for the digit replantation cohort. Hospitals that were privately owned, general, large, urban, or teaching had a significantly greater number of replantations than small-medium, rural, non-teaching, public, or children's hospitals. Privately owned (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.06–3.06; p = 0.03) and urban (OR: 2.29; 95% CI: 1.41–3.73; p = 0.005) hospitals were significantly more likely to perform replantation. Urban (OR: 4.02; 95% CI: 1.90–8.47; p = 0.0003) and teaching (OR: 2.11; 95% CI: 1.17–3.83; p = 0.014) hospitals were significantly more likely to perform a revision procedure following primary replantation.

Conclusion Private and urban hospitals were significantly more likely to perform replantation, but urban and teaching hospitals carried a greater number of revision procedures following replantation. Despite risk of requiring revision, the treatment of pediatric digit amputations in private, urban, and teaching centers provide the greatest likelihood for an attempt at replantation in the pediatric population. The study shows Level of Evidence III.

Keywords

pediatric digit amputation - pediatric digit replantation - hospital characteristics - teaching status - ownership - location


Publication History

Article published online:
19 November 2020

© 2020. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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