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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Readmission and Revision Rates for Replantation: A Survey of the Nation Readmission Database
Kareem Hassan, MD; Patrick Reavey, MD, MS
University of Chicago, Chicago, IL

Background: Due to the limited number of digital replants performed nationwide, it can be difficult to aggregate large samples to analyze variables associated with outcomes and future follow up of replant patients. Prior studies have analyzed data from national databases to identify factors associated with the success rate of replantation on inpatients. However, prior studies tracked patients only through a single admission. Using a novel database, this study aims to identify factors associated with future readmission, revision and failure in digital replantation.

Materials & Methods: The National Readmission Database (NRD) of the Healthcare Utilization Project was queried to identify all patients that underwent a finger or thumb replantation from 2013-2014. Diagnosis and procedure code data was evaluated to identify the number of replantations and the cause for readmission for each respectively. Time to readmission was compared for failed replantation versus admissions for other causes. Odds ratios were determined for failure and revision by hospital type and size.

Results: From 2013-2014, 1197 patients underwent replantation of an amputated digit in the United States. The average age of the patients was 38.9. Approximately 2.5% of patients were readmitted for amputation following the initial replantation at a mean of 10.3 days from discharge. Only 3.2% of patients had an additional admission and/or surgery following replantation. The most common reasons for readmission was infection (32.5%), amputation (30.5%), debridement (14.9%), pedicle revisions (8.3%), non-union (6.5%), PTSD (2.77%), contracture (1.14%) and adhesions (1.14%). The average time to revision surgery was 42.8 days from replantation.

Consistent with prior studies, large, metropolitan teaching hospitals performed the majority of the replantations. Teaching institutions were more likely to treat patients for failed replantation, as well as perform revision surgeries for complications from replantation (OR 2.57, P <0.05). Hospital ownership and size were not correlated significantly with revision or failure rate.

Conclusions: According to a national database, only 3.2% of replants undergo revision surgery in the first year. This is significantly less than published rates of revision surgery from large single institution series. The higher number or replants and the higher secondary revision at teaching hospitals further supports the establishment of regional centers of excellence.


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