title: Transfers for Hand Surgery Correlate with Increased Reoperations for Complications.
abstract: Wrist, hand, and finger trauma are the most common nonlethal injuries presenting to emergency departments. In Tennessee, lack of available hand care, particularly the need for emergency hand surgery, could be detrimental to patient outcomes. This is a retrospective outcomes study of patients requiring revisional hand surgeries. Patients were identified and stratified by distance to Vanderbilt University Medical Center (VUMC) to determine if patient complications increase with distance from VUMC. As distance of patient county of residence from VUMC increased, per cent of patients without a complication decreased (P < 0.0001). Counties without 24/7 comprehensive hand call also showed a distance difference in complication rates. Per capita income and mean household income showed no effect on complications. Distance from treating facility is correlated with patient outcomes and need for revisional surgery. Limitations in care availability in Tennessee are not specific to hand surgery. If the trend toward poorer outcomes as a result of limited local care availability extends to other specialties, this could have implications regarding health-care realignment. Specifically for patients with complex injuries or conditions that will be referred to centralized flagship hospitals, increases in patient travel may limit positive outcomes.
authors.affiliation: College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Hunter J
authors.initials: HJ
authors.lastname: Rooks
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Anthony
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Sexton
authors.forename: Andre P
authors.initials: AP
authors.lastname: Marshall
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Shack
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Thayer
mesh_terms: D004632:Emergency Medical Services / Q000600:supply & distribution; D006230:Hand Injuries / Q000601:surgery*; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007182:Income; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012111:Residence Characteristics; D012189:Retrospective Studies; D013714:Tennessee