title: Racial Variation in Treatment of Traumatic Finger/Thumb Amputation: A National Comparative Study of Replantation and Revision Amputation.
abstract: BACKGROUND
  Traumatic finger/thumb amputations are some of the most prevalent traumatic injuries affecting Americans each year. Rates of replantation after traumatic finger/thumb amputation, however, have been declining steadily across U.S. hospitals, which may make these procedures less accessible to minorities and vulnerable populations. The specific aim of this study was to examine racial variation in finger replantation after traumatic finger/thumb amputation.
  
  
  METHODS
  Using a two-level hierarchical model, the authors retrospectively compared replantation rates for African American patients with those of whites, adjusting for patient and hospital characteristics. Patients younger than 65 years with traumatic finger/thumb amputation injuries who sought care at a U.S. trauma center between 2007 and 2012 were included in the study sample.
  
  
  RESULTS
  The authors analyzed 13,129 patients younger than 65 years with traumatic finger/thumb amputation. Replantation rates declined over time from 19 percent to 14 percent (p = 0.004). Adjusting for patient and hospital characteristics, African Americans (OR, 0.81; 95 percent CI, 0.66 to 0.99; p = 0.049) were less likely to undergo replantation procedures than whites, and uninsured patients (OR, 0.73; 95 percent CI, 0.62 to 0.84; p < 0.0001) were less likely than those who were privately insured.
  
  
  CONCLUSIONS
  Despite advancements in microsurgical techniques and the increasing use of reconstructive surgery in other fields, finger/thumb replantation rates are declining in the United States and vulnerable populations are less likely to undergo replantation after amputation injuries. Regionalization of care for these injuries may not only provide a higher quality care but also reduce variations in treatment.
  
  
  METHODS
  Risk, III.
authors.affiliation: Ann Arbor, Mich. From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School; and the Institute for Healthcare Policy and Innovation, University of Michigan.
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
authors.forename: Peter R
authors.initials: PR
authors.lastname: Swiatek
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000673:Amputation, Traumatic / Q000208:ethnology* / Q000601:surgery*; D016000:Cluster Analysis; D016208:Databases, Factual; D005260:Female; D005383:Finger Injuries / Q000208:ethnology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012092:Replantation / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013933:Thumb / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult