title: Epidemiology of digital amputation and replantation in Taiwan: A population-based study.
abstract: BACKGROUND
  Publications on digital amputation and replantation have been mostly derived from case series in high-volume hand surgery practices, and epidemiological studies are few. This study used a population-based dataset to illustrate the incidence of digital amputation, patient and hospital characteristics, and their relationships with replantation.
  
  
  METHODS
  A claim for reimbursement dataset (2008) was provided as a research database by the Bureau of National Health Insurance, Taiwan. Patients with ICD-9-CM coded as digital amputation (885 and 886) were included. These were cross-referenced with procedure codes for replantation procedures (84.21 and 84.22). We defined the patients who underwent thumb replantation (84.21) and thumb amputation (84.01) during a single hospitalization as replantation failure. Patient and hospital characteristics were studied with statistical analysis.
  
  
  RESULTS
  In total, 2358 patients with digital amputation were admitted (1859 male, 499 female), mean age 39.2 ± 15.5 years. The incidence was 10.2/100,000 person-years. The highest incidence was 14.7/100,000 person-years in the age group 45-54 years. Machinery and powered hand tools caused 68.8% of digital amputations. Thumb amputation [odds ratio (OR): 1.35, p = 0.01], private hospital (OR: 1.40, p = 0.01), medical center (OR: 2.38, p < 0.001), regional hospital (OR: 2.41, p < 0.001) and hospitals with an annual volume >20 digital amputations (OR: 4.23, p < 0.001) were associated with higher attempt rates for replantation. Elderly patients (age >65 years) had higher risk of thumb replantation failure (OR: 32.30, p = 0.045), while hospitals with >20 annual replantations had lower risk (OR: 0.11, p = 0.02).
  
  
  CONCLUSIONS
  Our study of the National Health Insurance database characterized the epidemiology of digital amputation patients undergoing replantation and the facilities in Taiwan where these procedures are performed. The hospitals treating more digital amputation patients had higher attempt rates and lower thumb failure rates.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Dun-Hao
authors.initials: DH
authors.lastname: Chang
authors.affiliation: Department of Administration, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Shih-Yu
authors.initials: SY
authors.lastname: Ye
authors.affiliation: Division of Traumatology, Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
authors.forename: Li-Chien
authors.initials: LC
authors.lastname: Chien
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: sma@vghtpe.gov.tw.
authors.forename: Hsu
authors.initials: H
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012092:Replantation / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D013933:Thumb / Q000601:surgery*; D017211:Treatment Failure
keywords: amputation; digit; epidemiology; finger; replantation