title: Epidemiology of upper extremity replantation surgery in the United States.
abstract: OBJECTIVE
  Replantation remains an important technique in the management of hand trauma. Given the resources necessary for a successful replantation program, regionalization of replantation care may ultimately be required. The purposes of this study were to analyze the geographic distribution of upper extremity replant procedures, analyze factors of patients undergoing replantation, and characterize the facilities performing these procedures.
  
  
  METHODS
  We performed a cohort study using the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2001, 2004, and 2007. Patients with an upper extremity amputation were defined, and a subgroup of patients undergoing replantation was delineated. We analyzed patient demographics and injury characteristics and characteristics of treating facilities.
  
  
  RESULTS
  A total of 9,407 patients were treated for upper extremity amputation, 1,361 of whom underwent replantation. Mean age of patients undergoing replantation was 36 years (range, 0-86 y), compared with 44 years (range, 0-104 y) in patients not undergoing replantation. Hospital charges (P < .001) and length of stay (P < .001) were significantly higher for patients with replantations versus those without replantations. Patients treated at teaching facilities were more likely to undergo replantation than those at a non-teaching facility (19% replantation rate at teaching hospitals vs 7% at non-teaching). Large hospitals and urban hospitals were more likely to perform replantation. Self-pay, Medicare, and Medicaid patients all had lower replantation rates than patients with other payer status.
  
  
  CONCLUSIONS
  Patients who undergo replantation are younger, incur higher hospital charges, and have longer hospital stays compared with patients who do not undergo replantation. Treatment at large, urban, and teaching facilities is associated with higher replantation rates. Payer status appears to have some bearing on replantation rates. Further studies are needed to better elucidate the relationship between patient and injury characteristics, treatment location, and outcomes, to adequately distribute the finite resources for replantation.
  
  
  METHODS
  Economic and Decision Analysis IV.
authors.affiliation: Division of Plastic Surgery, University of Washington, and the Harborview Injury Prevention and Research Center, Seattle, WA, USA. friedri@uw.edu
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Friedrich
authors.forename: Louis H
authors.initials: LH
authors.lastname: Poppler
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mack
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000673:Amputation, Traumatic / Q000453:epidemiology* / Q000601:surgery*; D001134:Arm Injuries / Q000453:epidemiology / Q000601:surgery; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005383:Finger Injuries / Q000453:epidemiology / Q000601:surgery; D006230:Hand Injuries / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012092:Replantation / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D034941:Upper Extremity / Q000293:injuries*; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult