• Chung-Chen Hsu, Sunitha Malay, Ting-Ting Chung, LohCharles Yuen YungCYYCenter for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan, St Andrew's Centre for Plastic and Reconstructive Surgery, Broomfield Hospital, Court Road, Chelmsford, Essex, CM1 7ET, United Kin, Yu-Te Lin, and Kevin C Chung.
• Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taiwan; College of Medicine, Chang Gung University, Taiwan.
• Injury. 2020 Nov 1; 51 (11): 2532-2540.

BackgroundTraumatic finger amputations cause a substantial burden to health care system. The purpose of this study is to investigate the epidemiology of traumatic finger amputations, the incidence of replantation attempts and to examine the patient, surgeon, and hospital characteristics that were associated with replantation attempts.MethodsWe examined 49,469 patients with traumatic digit amputations from the National Health Insurance Research Database (NHIRD) of Taiwan. We used Chi-square, ANOVA tests, and regression analysis to determine the important factors in decision to replant.ResultsThe replantation rate increased significantly with increased hospital volume (low-volume: 4.7%, medium-volume: 19.1 % and high-volume: 35.9 %). Regional hospitals were more likely to attempt replantation (odds ratio = 1.35). Low-volume hospitals had a replantation failure rate of 11.1 %, medium-volume 19.7 % and high-volume hospitals had 13.8 %.ConclusionWith the national health insurance coverage, hospital volume is a substantial factor to encourage microsurgical-trained staff to perform digit replantation when indicated. The findings from this study will support government initiatives to foster and reward regionalization centers with high to medium case volume of replants to manage this critical function restoring procedure.Copyright © 2020. Published by Elsevier Ltd.

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